2012 Health and Social Care Act (HSCA)
Last Updated: August, 2019

The 2012 HSCA is the Act of parliament that resulted from the  Health and Social Care Bill  that was passed on 20th March 2012. The Act came into effect early in 2013. On the day it was passed Clive Peedell, Deputy Chair of the NHS Consultants' Association said:

England's biggest ever robbery took place today - The NHS was stolen from under the noses of the public by the Health and Social Care Act.

David Owen - one of the very few members of the House of Lords who fought against the Act - said on the day the Act was passed:

If this goes through, the NHS as we have seen it, believed in it and persuaded the electorate that we support it, will be massively changed. It will take 5, 10, 15 or maybe 20 years, but unless we pull back from this whole attitude there will be no National Health Service that any of us can recognise, and tonight I feel one thing only: overwhelming sadness.

Clause 1 ended the duty of the Secretary of State for Health to provide universal and comprehensive health services in England.

Other consequences of the Act include:

Section 75

Section-75 of the Act (signed off by Earl Howe) is designed to create a competitive market in health services. It sets out far-reaching requirements for Clinical Commissioning Groups (CCGs) to put services out to competitive tender.

Section-75 removed the option for an in-house commissioning process even if local people wish it. CCGs are forced to tender out all contacts even if they feel the local hospital is doing a good job. The legal fees required to facilitate this process cost the NHS approximately £77-million a year.

Section-75 states that there are negligible direct costs to patients, commissioners or providers of competitive tendering. In response David Lock QC wrote:

That statement would be laughable if this were not so serious. Another part of government, the Cabinet Office, has recognised the huge costs of procurement exercises and is complaining that too much cost is imposed by these exercises. This appears to be another case of a total absence of joined up government. Procurement processes are hugely expensive and they delay contracts for extended periods. Conservative MPs ought to have learned that from the West Cost Rail tendering debacle which left the Department for Transport with a bill of £50-million when just one tender exercise went wrong. These regulations will impose countless procurement competitions on the NHS, and cause vast resources to move from patient care into administration.

 Professor Allyson Pollock , David Price and Peter Roderick analysed the legalese framing the Act, they concluded that:

The Act legislates for reductions in government funded health services as a consequence of decisions made independently of the secretary of state by a range of bodies...

[It fails] to make clear who is ultimately responsible for people's health services.

[It] creates new powers for charging [and] ...signals the basis for a shift from a mainly tax financed health service to one in which patients may have to pay for services currently free at the point of delivery.

The 2012 HSCA is effectively the NHS Abolition Act because it paves the way for extensive  privatisation  and break-up of the NHS. This is a consequence of giving away control of the NHS to largely unaccountable bodies, which further enables sweeping changes that would otherwise have had to overcome parliamentary scrutiny (see  Big Picture - Post 2012 NHS Plans ). These changes are rapidly moving us towards the US-style system, like  Medicare , where health services are publicly funded but privately delivered for profit, some of the harmful effects include:

  • Worse outcomes for patients.
  • Cherry-picking patients to increase profits.
  • Greatly increased administration costs arising from the marketisation of the NHS.

    The costs of implementing the reforms in the Act are estimated at £3-billion. A further £1.6-billion was spent on redundancy payments. 4,000 of the managers made redundant were rehired when the Department for Health realised that experienced managers were needed during the transition.

  • Destabilisation of the public service.
  • Antisocial behaviour by the private sector.
  • Loss of accountability and transparency.

A 2014 Guardian newspaper article reported a Department of Health spokesperson saying:

Our bureaucracy-busting reforms put power in the hands of local doctors and nurses and are saving the NHS over £1-billion per year. There are now nearly 7,000 fewer managers and over 16,450 more clinicians than in 2010.

This statement is a complete reversal of the truth. The 2012 Health and Social Care Act created yet another significant increase in layers of bureaucracy. The lines of accountability have become so complex that the  Royal College of General Practitioners  described them as a spaghetti junction. On this Professor John Appleby said:

While there was once a simple accountability hierarchy from front-line services to the Secretary of State for Health, there is now a complex system of public and private providers, with a plethora of regulators who impact on what managers need to do.