Big Picture - Post 2012 NHS Plans
Last Updated: March, 2019

Many plans have issued forth from  NHS England  since the  2012 Health and Social Care Act . The sheer number of these plans can make it hard to understand what is happening to the NHS. Some campaigners have argued that the resulting obfuscation is deliberate, which is not unjustified as a significant amount of what is happening to the NHS is decided upon in secret, without any democratic mandate, and without any evidence base. The following is an attempt to put these plans into a broad context with a simple narrative:

Since the creation of the NHS, our health services have been provided by two parallel systems, NHS health care and local authority social care (see  National Health Service Act ). Before the  NHS and Community Care Act  in 1990 (which introduced a purchaser-provider split and other market mechanisms), NHS health care was tightly integrated. The NHS was one of the most efficient and largest organisations in the world - even as of 2015 only the Chinese People's Liberation Army, Walmart and the Indian Railways directly employed more people. You can then think of the various parliamentary Acts and plans from the late 1980s up to and including the very significant 2012 Health and Social Care Act as mechanisms, not just to introduce private provision and reduce public provision, but more fundamentally: to structurally fragment the NHS and all other health services, to make all health service institutions adopt a corporate structure and operate like businesses, and to change the public's relationship with health services in order to shape public opinion in readiness to accept a full consumer market in health care. As Noam Chomsky famously said:

The 2012 Health and Social Care Act effectively abolished the NHS. Crucially, the Act created a new non-departmental public body called 'NHS England' to which responsibility for the NHS was given. This has allowed for many plans (delivering the sort of sweeping changes needed for large scale  privatisation ) to be made without parliamentary oversight.

To have a full market in health care, the now fragmented health system is ready to be rebuilt in the form of multiple US-style  Accountable Care Organisations (ACOs) .

Two overarching plans have been written by NHS England CEO  Simon Stevens . In 2014 he produced a 5 year plan (up to 2019) called the  Five Year Forward View , then in 2019 he released a 10 year plan (up to 2029) called the  NHS Long Term Plan . Both of these plans mandate a variety of changes that ultimately reshape the NHS in the style of ACOs.

This transformation is being sold to the public as  integration  through the lie that it will remove the purchaser-provider split and join up health and social care services. ACOs are the pinnacle of 'market integration', not health service integration.


  1. The Five Year Forward View and the NHS Long Term Plan set out proposals with implications to rebuild the health service in the form of Accountable Care Organisations. NHS England divided the English NHS into 44 regional footprints.
  2.  Clinical Commissioning Groups (CCG)  working together in each of the 44 footprints were mandated to develop a  Sustainability and Transformation Plan/Partnership (STP) . STPs have evolved into plans for  Accountable/Integrated Care Systems (ACSs/ICSs) .

    The regional footprint that South Tyneside is part of was originally defined by the NTWND STP and includes North Tyneside, Tyne and Wear and North Durham. The ACS/ICS under development in our area has extended the original STP footprint to include North Cumbria and everywhere down the east side from Northumberland to North Yorkshire, incorporating a total of 12 CCGs.

  3. ACSs/ICSs are partnerships/alliances between CCGs and health care providers such as NHS Trusts, GPs and community health care providers operating within a regional footprint. They work together to share a fixed restricted budget to provide health and social care services for the people of that regional footprint. This is driving a fundamentally new arrangement of our health services leading to a reduction of accountability, and it dovetails with  efficiency savings  involving mergers and service closures in order to match public health services to lower levels of funding.
  4. NHS England would like ACSs/ICSs to eventually be delivered by a lead provider who will be awarded an  Integrated Care Provider Contract . The lead provider is an Accountable Care Organisation - also known as an Integrated Care Provider (ICP). The ACO/ICP will take control of health services within each regional footprint, controlling the budget, deciding which treatments are available, and which treatments are to be means-tested (also see  Personal Health Budgets ). These huge contracts will attract bids from multinational health corporations like  UnitedHealth .
  5. The NHS will be effectively split into 44 separate regional health systems, each potentially controlled by a multinational corporation. See  Medicare  for an idea of the implications.