Professor Allyson Pollock
Last Updated: August, 2019

Professor Allyson Pollock is the Director of the Institute for Health and Society at Newcastle University. She has been researching into NHS privatisation and its consequences for over 20 years, and is author NHS plc: The Privatisation of Our Health Care, and numerous articles including A war of attrition against hospital services in South Tyneside and across the country.

Professor Pollock is one of the architects of the NHS Reinstatement Bill (a parliamentary bill intended to reinstate the English NHS after it was principally abolished in 2012). She is one of five claimants (including  Professor Stephen Hawking ) who took the government to court in an attempt to stop the implementation of U.S. style  Accountable Care Organisations  in England.

Professor Pollock has presented many discussion and public lectures in her tireless effort to raise public awareness. Some of her presentations include: the TEDx talk Privatisation of the NHS (2014), NHS Post Election Reflections (2017) and The Dismantling of our NHS (2017)

Professor Pollock has supported the campaign in South Tyneside and Sunderland, not least by making herself available for public meetings, including the meeting at Hedworthfield Community Centre in 2017 and the one at Brinkburn Community Centre in 2019.

The following is a talk given by Professor Pollock at Newcastle University (October 2017), in association with Keep Our NHS Public North East. The following is an abridged transcription of Professor Pollock's talk together with the slides.

It's wonderful to be here in the North East. I know many of you are here because of your deep commitment to the NHS, and because we all want to know what we can do about what is happening.

Some of you will have experienced a time before there was an NHS. I recommend that those of you who were not around before 1948 actually go and speak to the people who were, because they understand what it means to live in a country without an NHS. The people who were around before 1948 know what it means to have the fear of not having health care, and not being able to pay for health care. That is why the NHS was brought in, to give everybody freedom from fear. It is bad enough being sick, but to also fear [health care costs] is quite extraordinary.

I am going to tell you what is happening to our NHS and how it is being dismantled to make way for a U.S. [style] health care system. I will touch briefly on the high costs and unfairness of market-driven U.S. health care, and I will try to explain the recent developments that have taken place in the last five years [2012 to 2017].

Don't worry if you [have trouble understanding at first]. It is very complicated and the government hasn't explained what is going on. It is like putting together a giant jigsaw.

[To recap why we have an NHS:] The country was broke [after the Second World War], there were extraordinary inequalities in health and wealth, and as William Beverage said, it was a needless scandal that [the government] was not preventing it, and that people were living in dire poverty. That is what we are returning to in many parts of the country.

William Beverage, who was a liberal, came up with a radical plan for social security, known as the Welfare State. This was founded on five pillars [taking on the five giants]:

'Idleness' was about employment, 'squalor' was about housing, 'disease' was about health services, 'ignorance' was about education, and 'want' was about social security, pensions and unemployment benefits.

What we have seen over the last 30 years is a rolling back [of the Welfare State], and a return of the five giants. The NHS is only one of the pillars which make a safe and secure society.

When Aneurin Bevan brought in the NHS, he said it was nothing to do with affordability. The country was broke after the [Second World] War, but it would none-the-less have to raise the funds for the services it pledged to provide. So it was an entirely political decision to have a national health service. Having taken that decision it was also political to decide how much money it should have.

We need to remember Bevan's words at the moment as the government brings in the most draconian charges for some of the most vulnerable people in the country.

The NHS was built on fours pillars:

  1. Public Funding - meaning centrally funded.
  2. Public Ownership - all the bits of the health services were brought together and nationalised in 1948.
  3. Public Accountability - not just national, but local.
  4. Public Provision - not the case for everything, but for the most part services were under public ownership and control.

The idea was that we would have equal access for equal need, universal comprehensive care, free at the point of delivery. The extraordinary thing about the NHS, is that it was the most successful and popular of all the welfare institutions, and it became the model [health care system] for the rest of the world, not just because it was fair and universal, but because it was incredibly low cost. The costs of the NHS was around 4 percent of GDP for the first 30 to 40 years. Throughout Europe - Norway, Sweden, Denmark, Italy, Spain, Portugal - they all followed suite. Many of them also adopted the Beverage plan.

So the NHS is something to be incredibly proud of, not just because of what it did for its citizens, but because of what it did for the rest of the world.

In contrast, the U.S. was the odd one out. They never managed to put in a universal health care service. Not only that, [the U.S. health care system] remains the most expensive, the most inefficient, and the most unfair service in the world. It is provided via the market using for-profit providers. There is no country in the world that has ever delivered universal health services through a market.

[From the above slide] you can see the U.S. is the outlier, spending nearly 18 percent of GDP, almost twice what the UK spends on health care. You can see that there is a considerable chunk (the dark red line) that is government funding. The rest of it is private health insurance and out-of-pocket payments (amounting to nearly one-fifth of U.S. GDP).

Not only is the U.S. health care system the most expensive, it is the most unfair. Denial of care is routine. In the U.S. almost 60 million people (despite the Obama plan) still have no access to health care, or sub-optimal access.

Bankruptcies [in the U.S. resulting from health care costs] are very common place. They account for about 40 percent of all bankruptcies. Nobody [currently] goes bankrupt in the UK for want of health care, but it is routine in the U.S.

The U.S. health system is also incredibly wasteful. There is over-treatment and under-treatment, and this is well documented by the U.S. Institute of Medicine [see above]. They carried out a study [in 2012] in the U.S. to look at the excess costs of health care.

In the market place, there is an incentive for people to over-treat if people can pay, or to under-treat if people can't pay. Markets also bring new costs that a public system does not have - the administrative costs - billing, invoicing, commercial contracting, litigation etc. There is an incentive to over-charge, and there are missed prevention opportunities, either because people are denied care and get treated too late, or because there is no money in prevention (we see that here [in the UK] with children's services, vulnerable people and older people's services). [As you can see from the above slide, the total excess health care costs for the U.S.] came to nearly 1-trillion dollars in 2009, nearly one third of their entire health care budget (7 percent of their entire GDP) which is totally wasted, and yet you still have over 60 million people being denied health care.

[The above slide shows why the U.S. health care system is so expensive.] Insurer Marketing and Profit [is the largest extra expense] because these are for-profit corporations. Their shareholders must have a return on their investment. Then [on top of that] there is all the billing, invoicing, physician billing, and administrative costs.

In contrast to our NHS (before we had the  internal market ), the administration costs used to take only about 4 to 6 percent of the NHS budget. It doubled in 1990 when the internal market was introduced. It is probably approaching 20 to 30 percent today, but the government does not tell us how much it costs.

The more money you spend on lawyers, on management consultants, on billing and invoicing, the less you have for patient care and staffing, the money leaks out of the system. In the UK it used to be the case that we would spend about 80 percent or more of the budget on staffing and medical care, contrasted with the U.S. where it is less than 64 percent.

Not only is the [market system] costly and inefficient, but the other thing that happens is fraud. The pharmaceutical industry engage regularly in fraudulent marketing, billing and cartels. [Again] it is well documented by many academic studies, so-much-so that the U.S. Department of Justice has a special unit dedicated to health care fraud. [Health care fraud] costs the U.S. close to 100-billion dollars a year according to figures from 2014/2015, and it is rising. Those figures do not account for all the fraud. Some of the fraud is due to over-billing, charging for treatments that are not being done, or performing treatments that people don't need. For example,  Health Corporation of America  was carrying out heart operations on people who did not need them.  UnitedHealth  has also been done for fraudulent billing. This is very routine!

[As you can see from the above slide] the health corporations earn billions of dollars, the chief execs earn hundreds of millions of dollars and stock options every year. Some of these are already in the UK NHS, including the aforementioned Health Corporation of America and UnitedHealth. All of the health corporations listed above have been implicated in fraud, and UnitedHealth particularly so.

The U.S. health care system is dominated by large for-profit provider corporations and insurers. It is characterised by denial of care. The private providers are always trying to extract as much as they can, additional user charges, co-payments and deductibles are common place. So if you think you have a health insurance plan, you can forget it, because there are always the deductibles and co-payments often running into thousands of dollars.

Another feature of the U.S. health care system, are the  Accountable Care Organisations . That term has been imported and is being used in the UK.

Words of Margaret Chan, Director General of the World Health Organisation (WHO)

[As mentioned earlier] markets don't work in health care. Not one study has shown that you can provide universal health care through the market using for-profit providers, and we have our own experiments in this country.

The market works on risk selection. It has to pick and choose the profitable patients, the profitable treatments and the profitable services [which need to be separated from the unprofitable ones, see  Path to Excellence ]. It is all about risk selection, and not about inclusion, which is in contrast with [the founding principles of] the NHS, everyone being covered regardless of age, colour, sex, and where they came from.

In 2015, even the World Bank joined the World Health Organisation in stating that 'universal health care is a critical component of our sustainable development goals', but we are drifting further away from this ideal in the UK because so many of the ideas are being imported directly from the U.S.

 Simon Stevens  is [at the time of writing] Chief Executive of  NHS England , which is the body responsible for commissioning health services throughout England. [It is important to note that Simon Stevens] was formally a policy advisor to the Secretary of State for Health, and also the policy advisor for Tony Blair, so he was very influential during the New Labour period, and that was when many of the most destructive policies towards the NHS took place. In 2004 Simon Stevens became President of [the aforementioned] UnitedHealth, which is penetrating many countries throughout the world. Stevens had also been at UnitedHealth many years earlier as a Harkness Fellow. Stevens has a track record in the U.S., so it made sense for the Conservative government to appoint him as Chief Executive of NHS England.

Markets need special structures and bureaucracies to allow them to select out profitable patients and treatments. This is a very different sort of bureaucracy to the public administration that we have been used to. The U.S. has been particularly keen on markets, because it allows it to follow through on the idea of the small state [(vaunted by Oliver Letwin - see  Britain's Biggest Enterprise )], shifting risks and costs from the population as a whole (social solidarity) onto individuals.

The NHS was very resistant to markets, because the tiny act of parliament - the  National Health Service Act 1946  - protected the NHS from the excesses of the market. It kept market structures out of the NHS through integration. The four pillars of the NHS - public ownership, public control, public accountability, and public funding - had been designed to keep the market out. In 1987, Margaret Thatcher was not very happy with this, so her government began to think about how to bring in the elements of the market, allowing them to break up the NHS into competing units. They needed a lot of legislation, not just one Act of parliament, but over 30 Acts of parliament, which shows how strong the 1946 Act was at keeping the market out.

Catering, cleaning and portering was privatised in the 1980s, but the really big one (under Kenneth Clark) was the  National Health Service and Community Care Act  which introduced the internal market. That brought in shadow market structures, it brought in market disciplines without breaking up public ownership and control. There were then various other Acts, that culminated in an enormous Act of parliament - the  2012 Health and Social Care Act (HSCA) . Even though [by that time] there had been 30 Acts of parliament, the 437 page HSCA was necessary to accomplish the dismantling of the NHS.

At one time all of the services in the NHS were integrated. One of the frustrations for the government was that it needed to find a way of unbundling them in order to put a price on them, and in order to put them in a market.

Pharmaceuticals were always in the market. Dentistry is now priced and increasingly private. Optical services are private. Elective surgery is being increasingly unbundled (see  Path to Excellence ). Catering, cleaning, laundry and portering were early victims, [you can see some others on the above diagram], and now we are seeing this happen to GPs (see  Primary Care Networks ).

I'm sure there is not a day that you don't wake up to hear what a burden all the old people are, constantly demanding health care, ageing so much that they are placing an impossible strain on our resources with their growing complex needs. We are told this over-and-over again. Well, it is true that the population is ageing and their needs are growing, but they are not making extra demands on the service, rather their needs are not being met, and the government is slashing the funding they need for care.

Many older people find it difficult to navigate a complaints system, and there is a vulnerability that comes with frailty. [That might explain why] dismantling  long-term care  was one of the government's first acts, dismantling all the pillars of public ownership and control, public provision, public funding and public accountability.

The NHS and Community Care Act carved out long-term care [from the NHS] and transferred most of it to local authorities. It was a good idea to have care closer to home and in the community, the problem was that it was not funded properly, and it moved care from a service that was free at the point of delivery to one that is charged for.

[In the above slide] you can see what is happening. The blue areas represent the NHS, and you can see that back in 1972 beds for older people (geriatric beds), beds for the mentally ill and beds for people with learning disabilities, numbered over 220-thousand in the NHS. By 2014 the combined total is less than 50-thousand, yet anyone old is called a bed blocker or a delayed discharge. The facilities that once contained these beds have been sold off for housing and other market developments. Local Authority provision has also all but disappeared. But is has all be replaced dramatically by private for-profit operators, so people must pay for their care until they are too poor to pay. The above graph is important because it shows clearly the closure of beds in the NHS and Local Authorities, and their enormous substitution with private for-profit care homes.

Local Authorities were incentivised to sell their Local Authority residential care homes [sometimes for a nominal fee such as] one pound!

[The above slide] shows what has happened to the numbers of Local Authority supported adults. It increased with the transfer of long-term care from the NHS in 1990, but look what happened to the public provision. Local Authorities were providing most of the care themselves. A combination of government underfunding and various financial incentives, means Local Authorities were insentivised to shift care into (what is mainly) for-profit corporations. The UK now has more for-profit beds per-head of population even than the U.S.

The numbers of people in receipt of social services reached a high of about 1.6 million around 2007/2008, then after the financial crash there has been a dramatic fall [see slide above - this data appears to refute the government / NHS England claim that spiralling demand is a significant factor in making the NHS unsustainable].

[In summary] what we have had is the privatisation of our care homes, the end of NHS funded long-term care [for most people], replaced with care that is charged for, and Local Authorities being left with a problem to solve [in providing their share of care services] while their own budgets have been cut.

[The above slide] shows the long-term care industry was worth £29-billion in 2009 (and it will be much higher than that now). The people who came in to own and operate these care homes included bankers and brewers!

[The above slide] shows some of the familiar providers. You might remember that Southern Cross collapsed disastrously. So long-term care was carved out of the NHS, it was no longer free at the point of use, and no longer a national responsibility.

The NHS and Community Care Act deliberately targeted public ownership and control. In 1948 all the hospitals, the community services and centres were nationalised. Much of the nationalised estate was in [disrepair - some hospital buildings were 2-3 hundred years old]. There was a huge backlog of maintenance. There were many hospital building programmes that were never realised because the treasury would not find enough money to build the hospitals that we needed.

In 1990 the government chose not only to leave services crippled with the backlog in maintenance, [but to go further] and charge hospitals for their capital. They did this by making hospitals and community services into stand-alone Trusts that had to pay a charge to the treasury for their capital. The charge was paid out of the same operating budget that also paid for nurses and doctors. It was called a  Capital Charge , and it meant all hospitals (or any health service provider with land and buildings) had to pay a sort of annual rent. The capital charge had two components: an interest charge, and a public dividend capital charge. So the treasury acted like a banker and shareholder.

[As stated the Capital Charge did nothing to address the backlog of maintenance] so Norman Lamont adopted something called the  Private Finance Initiative . The government would no longer make new capital available, they would instead go to the private sector and ask them to raise money and build new hospitals. In return for building the hospitals, the NHS would [effectively pay a rent to the private investors for the use of the hospitals with guaranteed 30 to 60 year contracts encompassing the design, building and maintenance/operation of the new hospitals].

This is enormously expensive. [The bank of England base-rate] sits at around 0.5 percent [at the time of writing]. The Public Loans Board might charge 3 percent interest, but the bankers and builders [investing in a given PFI scheme] are charging anything from 8 to 16 percent [above the actual cost of building and maintaining the hospitals].

No PFI scheme [for hospitals] was signed until New Labour came into power in 1997.

[The above slide shows the impact of the new capital costs for some hospital Trusts in 2009/2010. The horizontal blue line represents the 6 percent of a hospital Trust's capital costs that were actually covered by money it received from the government as part of the hospital tariff payment system. The vertical bars show the total percentage of money taken from each hospital Trust's budget to pay for their total capital costs. Therefore the difference between the blue line and the top of each bar represents the percentage of each hospital Trust's budget that is diverted from clinical care to pay for capital costs.]

You can see that Durham and Darlington Trust was loosing [over 30 percent] of their operating budget - the same budget that was paying for nurses and doctors.

[The green bars on the above slide show the private money invested in all PFI schemes between 1990 and 2008, this is the actual 'capital cost' of the projects and it totals nearly £35-billion. The yellow bars show how much public (taxpayer) money will be given to the PFI investors over the lifetime of these PFI contracts, a total in excess of £191-billion.]

For every PFI hospital that was built, they would close three hospitals, selling off the land and the buildings to pay for the PFI contract. That has resulted in some really big cuts to the numbers of hospital beds. Hospitals with PFI contracts continue to be very 'hungry' [starved-for-cash]. The PFI contracts are legally guaranteed, the PFI investors have to be paid before patients are treated. The knock-on-effect is that neighbouring community hospitals and services have to close when the PFI hospitals go into deficit.

We are paying three times the actual cost for hospitals built using PFI schemes.

The knock-on-effect of PFI has not just affected hospitals. It has affected community services and mental health services. There have been waves of closures. The PFI hospital building programme is associated with one of the largest [waves of closures and downsizing] in the history of the NHS.

PFI has also meant that there are huge cuts to staff budgets. The workforce has had to be reduced to make PFI affordable.

This slide shows that investors putting half-a-million pounds into the Edinburgh Royal Infirmary PFI scheme, will eventually earn dividends worth £168-million. Investors putting just £100 into the Hairmyres Hospital PFI scheme, will eventually earn dividends worth over £89-million. Investors putting just £1000 into the Hereford Hospital PFI scheme, will eventually earn dividends worth over £55-million.

PFI contracts are not in the public domain, it is very difficult to get hold of them, but we managed to get three of them, and my colleagues did an analysis on the equity returns.

[An equity investor is just a fancy way of describing someone who has purchased shares in something. Banks have played a large role as equity investors in PFI schemes.]

I bet you wish you had invested in PFI! The Royal Bank of Scotland was an equity investor. After the [2008 financial] crash, PFI payments were important in rebuilding its balance sheet, just like many of the banks that we as taxpayers had already bailed out.

The PFI story is one of the great disposal of our NHS land and buildings, but now we are into another [phase of] disposals. Since the 2012 Health and Social Care Act, the government has divided the NHS estate amongst two companies:  NHS Property Services  and NHS Community Health Partnerships.

[Community Health Partnerships (formerly Partnerships for Health) are Department for Health owned companies. Their role is to set up public-private partnerships via the NHS Local Improvement Finance Trust (LIFT) programme. As you can see from the above slide, Community Health Partnerships own property used by a wide range of services including: GP practices, various Local Authority services, libraries, pharmacies, fitness centres, and a wide range of community and social care providers.]

The government is getting ready to privatise these companies, and all the land that was in Community Health Service Trusts, in Primary Care Trusts, GP premises etc. has been transferred to the ownership of these two companies, which are charging market rents and property management charges.

 Foundation Trusts  still own their own properties [but the  Naylor Report  has laid the basis for policy to induce them to sell at least some of it.]

[The above slide summarises the various artificial mechanisms that have been created over the years that force hospital Trusts to pay charges in relation to their capital, consequently making it harder for them to find enough money for clinical care. From 1990 there was the Capital Charge paid to the treasury. In addition, from 1997 there was PFI, then from 2012 we have the transfer of swathes of the NHS estate into property management companies who charge market rents and property management charges.]

Remember that many of the hospitals and community services were originally built by public subscription before the Second World War. They were built and funded by our grandparents [including for example, women working in the laundry for free in order to raise the money.]

[We have looked at the dismantling of the first pillar of the NHS - Public Ownership and Control. Now we look at the dismantling of the second pillar - Public Provision.]

They began by privatising surgery and elective care. This was done under New Labour with the  Independent Sector Treatment Centre (ISTC)  contracts. [This has been expanded to other services including: radiology, pathology, haematology, physiotherapy etc. Now the government has brought in a new contracts that allows some General Practices (GP surgeries) to be taken over by health corporations like Virgin and UnitedHealth.]

Some of the private providers that are taking over surgery services in the UK, and you can see that they are international global corporations. Netcare is South African, Ramsey is Canadian, Fresenius is German etc.
Some of the private providers that are taking over primary care in the UK.
Some of the private providers that are taking over public health (out-of-hospital) services in the UK, some of which are insurance companies.

There are only handfuls of the companies that can see enormous market opportunities!

[The above slide shows] what has been happening to the budget. We had one of the most efficient health care systems in the world. It stayed at around 4 percent of GDP (compared with 20 percent in the U.S.). It stayed like that for a long time, until we got to the internal market, and you can see it rising again after  NHS Plan 2000 . Tony Blair said that the rise was due to new investment, but most of that investment went on the expensive cost of contracting and commissioning.

[The rise in NHS costs] has become inexorable, and the private providers more demanding. They have been lobbying hard, with Simon Stevens and his cronies are in the background.

[The above slide shows]  Andrew Lansley , who was Secretary of State for Health. The BMJ described the 2012 Health and Social Care Act as Andrew Lansley's monster.

The words of David Owen, who was one of the few members of the House of Lords who fought the 2012 Health and Social Care Act as it went through parliament. He spoke those words in March 2012 on the day the HSCA became law.
The above slide shows the key legal changes resulting from the 2012 Health and Social Care Act. 'FTrust' refers to Foundation Trusts, who can now make up to half of their income from private patients. 'LAs' refers to Local Authorities who have new powers for charging for health services.

Meanwhile NHS deficits are rising. There is not a day that you do not hear about the deficit situation. It was nearly £2-billion in 2015/2016.

The government's solution as outlined in the  Five Year Forward View  is that we will have  integrated care , with new models of care. It is difficult to see how you can have 'integrated care' when you have commercial contracting that is compulsory.

What [the government] has done is to introduce these new terms:  Sustainability and Transformation Plans (STPs) ,  Accountable Care Systems  and  Accountable Care Organisations . None of these are legal forms, they are completely non-statutory. It is extraordinary, the government is putting in structures without having a legal basis for them! The reason [they are non-statutory] is that the government doesn't want to go through parliament, they want to [implement] it all using secondary regulations.

The words of Simon Stevens CEO of NHS England.

They say that they are ending the internal market, and yes they are, they are moving to an external market, and they say they are bringing about integrated funding.

[The above slide shows the old system that we had of  Strategic Health Authorities (SHAs) .] Many people think that STPs are like SHAs, they are convinced by Simon Stevens' words that STPs are geographic, but they are not! SHAs covered everybody that was resident in an area. SHAs were dissolved by the [2012 Health and Social Care Act] and replaced with CCGs. But CCGs don't necessarily cover everybody in an area, because residents can opt to go to GP practices in other areas, and membership of a CCG is through your GP practice.

I think it is very important that the definition of the population [that is covered for health care] is changing. STPs and CCGs are not geographic, they are person-based. [I.e. it's about persons for whom STPs and CCGs are responsible which is not everybody living in a geographical area.] We are moving towards the membership system associated with insurance systems.

One of the things that I think is remarkable about STPs is that the [government / NHS England DON'T refer to them as] 'areas', or 'boards', or 'authorities', but they call them 'footprints'. The thing about footprints is that they disappear, and they're blurred.

STPs have to make £29-billion of savings. Some of them are merging - I know that is happening here in the North East - with cuts and closures of hospitals, it's all well documented.

The great thing about these cuts and closures [so we are told] is that we will have new models of care, that will end competition and allow integration.

We have just seen the draft contracts for these new Accountable Care Systems in August [2017].

The Accountable Care Organisation (ACO) [that sits at the top of the Accountable Care System] can be a Foundation Trust, a private company or a Special Purpose Vehicle (SPV - which is a shell to protect the parent companies from risks).

ACOs can hold a commercial contract with lots of sub-contractors both private and public.

ACOs can get into joint ventures with private health insurers, property companies, and property service management, and some are starting to do this.

The idea that the government has is that groups of CCGs will bundle-up all their budgets, and instead of having lots of contracts, they will just have one giant corporate commercial contract [with the ACO]. In Manchester this contract is worth between 4 and 5 billion pounds.

These commercial contracts [which include needs assessment and service commissioning will move control] to the ACOs.

Over time other sources of funds coming into the ACOs will include money from [up-front] patient charges and [private] health insurance.

[As I mentioned earlier] this ACO contracting is not legal. So the government has brought in some primary legislation that it is consulting on, where it is trying to give a definition to an ACO. You can see that it is shifting responsibilities from the CCGs to the ACO so that the ACO can sub-contract health care provision.

In other words, what the government wants to do is to bundle up all the money from CCGs, local authorities and GPs into one giant contract and give it to this ACO body. They in turn will be responsible for sub-contracting health care. That ACO body can be Virgin etc. or it could be a Foundation Trust in partnership, but the ACO will responsible for deciding what care you get.

The government wording as used in their consultation and their ACO contract introduction.

[The above 2 slides quote the definition of a Special Purpose Vehicle as given by  PricewaterhouseCooper .] This is just like PFI all over again. PFI is done through a Special Purpose Vehicle. The ACO, in the governments mind, will be just like PFI, where the investors can extract money.

Questions that we need to be asking!

This is all very difficult [to understand] because the government has never consulted on it, specified what it intends to do, or what the implications are.

The government intends to bundle-up the budgets, give a capitation payment to a private provider (or public-private provider) to deliver your care.

This will not be like the old NHS where the Secretary of State for Health had a duty to provide health care to everyone, and they delegated that responsibility to Local Authorities and Primary Care Trusts. This is a new world of shifting sands!

The government is talking about integrating budgets for health and social care, but social care is means-tested and charged for, so how will the ACO decide which services will be free at the point of use, which services will be charged for, and which services you will no longer get.

The ACO contracts are for 10 to 15 years and there is scope in the contract for the terms to change.

What about accountability when you have layers of sub-contracting?

In 2012 when the Health and Social Care Act was passed, we realised that we had to do something fairly radical, which is why we got to work on a Bill to reinstate our NHS.

It took an Act of parliament to take away the NHS, the only way we will get our NHS back is by an Act of parliament. It is not too late, because the people working in the NHS and the people using the NHS still believe they have an NHS - that belief in it is really important.

The NHS Reinstatement Bill will get rid of the market (including the internal market) and it will re-nationalise - that is not impossible!

It has been a private members Bill, brought last time by Margaret Greenwood [(Labour MP for Wirral West)], we now need a new MP - lets hope someone from the North East comes forward - to table this Bill in parliament.

The NHS was a vision that has never been lost. People still believe that they have an NHS and that it is worth holding on to.

[In response to a comment about asylum seekers:]

The government wants to bring in a charging apparatus, because it needs it for ACOs to decide who is entitled to care and who isn't. This is the back door. By targeting the most vulnerable people first, it will actually bring in a charging administration for everybody.