National & Local Time-lines

The  National Health Service Act  created by the post-war Labour government Minister for Health - Aneurin Bevan - was passed allowing hospitals to be nationalised in preparation for the start of the National Health Service.

The  National Assistance Act  was passed, this put local authorities in charge of a subsidiary system for those in need of other 'care and attention'. It was concerned primarily with frail older people, but unlike NHS care, it was means-tested and subject to a statutory charge.

Together with the NHS Act 1946 two parallel systems of health care were established, and despite their limitations, they were a remarkable success providing health care free at the point of delivery, for everyone equally from the cradle to the grave. The NHS began on the 5th of July 1948.

Prescription charges were introduced during a 'financial crisis'. Prescription charges still only represent a fraction of the cost of many drugs, and as many groups of people are exempt from charges (including those over 60 or under 16, those suffering certain long term conditions and those in receipt of benefits) the vast majority of prescriptions (88 percent in 2012) are dispensed free.

The Ridley Plan on nationalised industries is published, it states that:

The process of returning nationalised industries to the private sector is more difficult than ever. Not only are the industries firmly institutionalised as part of our way of economic life, but there is a very large union and political lobby wanting to keep them so. A frontal attack upon this situation is not recommended. Instead the group suggest a policy of preparing the industries for partial return to the private sector, more or less by stealth. First we should destroy the statutory monopolies; second we should break them up into smaller units; and third, we should apply a whole series of different techniques to try and edge them back into the private sector.

A document from the Central Policy Review Staff (CPRS) - an independent unit in the cabinet office tasked with developing long term strategy and established by Edward Heath in February 1971 - stated that:

It is therefore worth considering aiming over a period to end the state provision of health care for the bulk of the population, so that medical facilities would be privately owned and run, and those seeking health care would be required to pay for it.

• The covert conversion of the NHS into a business -  privatisation  - begins with the  Griffiths Report .

• Margaret Thatcher says in an interview on television that she is going to conduct a review of the NHS. The review was conducted in secret.

• MP  Oliver Letwin  co-authored a paper with John Redwood called  Britain's Biggest Enterprise , that outlined the steps required to privatise the NHS in a piecemeal way:

  Might it not, rather be possible to work slowly from the present system towards a national insurance scheme? One could begin for example, with increased joint ventures between the NHS and the private sector; move on next to the use of 'credits' to meet standard charges set by central NHS funding administration for independently managed hospitals or districts, and only at the last stage create a national health scheme separate from the tax system

Routine eye examinations ceased to be free on the NHS. Opticians were then able to charge fees. This led to a two-thirds drop in the rate of eye examinations.

The outcome of Margaret Thatcher's review of the NHS was the creation of the  National Health Service and Community Care Act . This introduced the NHS internal market (also known as the purchaser-provider split).

 Capital Charging  is introduced.

• New Labour creates  NHS Plan 2000 , enabling private companies to become permanent providers of clinical treatment to NHS patients.
• The first  Private Finance Initiative (PFI)  hospital is opened.
• The National Bed Inquiry commissioned by health secretary Frank Dobson concluded that 3-thousand more hospital beds would be needed in the near future. The inquiry did not take account of the fact that policies had already set in motion changes leading to further reductions in bed capacity resulting from service closures and the fact that new hospitals being built with PFI were necessarily smaller with 30 percent fewer beds.

•  Primary Care Trusts  are created.
• District Health Authorities are replaced with 28  Strategic Health Authorities .
• Health Secretary  Alan Milburn  - advised by  Simon Stevens  - announced plans to offer patients who were already on waiting lists, opportunities to choose alternative (I.e. private) providers - paid for by the NHS at up to 40 percent above the NHS cost. (See  Independent Sector Treatment Centres ).
•  Payment by Results  is introduced.

•  Foundation Trusts  are introduced and  Community Health Councils  are scrapped.
• The Department of Health asked computer firms to design a computer system that would automatically upload patients' confidential GP medical records to a centrally held database called the  Summary Care Record .

• New Labour creates NHS Improvement Plan 2004
• Oliver Letwin co-author of  Britain's Biggest Enterprise , head of NM Rothchild Bank's Privatisation Unit, and author of Privatising the World tells a private meeting that the NHS will not exist within 5 years of a Conservative government.

• The drive to 'transform community services' begins. This meant separating them from  Primary Care Trusts  which had been responsible for delivering these services. Community services were given to free-standing purpose-made NHS Trusts, or they were floated-off outside the NHS by becoming non-profit  social enterprises .
• A study is commissioned by the Department of Health, and carried out by a team at York University, which demonstrates the inefficiency of NHS marketisation. The study showed that NHS administrative costs rose from 5 percent in the mid-1970s to 14 percent in 2003, resulting directly from the increased number of administration and managerial staff required to operate the NHS  internal market . This study was kept secret until 2010.
•  Connecting for Health  a largely non-operational IT Programme is introduced at a cost of £20-billion.
•  Jeremy Hunt  (who later became Health Secretary from 4th September 2012 to 9th July 2018) co-authored a book with Michael Gove, Tory MEP Daniel Hanaan and Greg Clark called  Direct Democracy , in which they call for the NHS to be dismantled. Co-author Daniel Hanaan is on the record saying: The NHS is a 60-year-old mistake.

 Serco  enters the UK health market with a five-year contract to run GP 'Out-of-Hours' services in Cornwall.

The government commissions Lord Darzi to look into re-configuring NHS services (yet again). Darzi's report comes up with the idea of  Polyclinics .

Catastrophic failure of care at Mid Staffordshire Hospitals (See  Francis Report ).

• The Unsustainable Provider Regime is introduced by Health Secretary Alan Johnson, giving draconian powers to the  Trust Special Administrator .
• In the wake of the financial crash  McKinsey  are commissioned to produce a report that heralds the start of truly massive and unprecedented cuts to the NHS budget.
• Following the  Mid Staffordshire Scandal , New Labour modifies 2006 legislation to make it easier to close hospitals.
• The first  Polyclinics  are introduced.
• John Nash - a private equity tycoon and chairman of  Care UK  - donates £21-thousand to Andrew Lansley's private office. Care UK was receiving 96 percent of its income from the NHS budget and stood to benefit significantly from further NHS privatisation.

•  Andrew Lansley's  'white paper',  Liberating the NHS , was published in July 2010, followed swiftly by the  Health and Social Care Bill .

  Kingsley Manning the business development director at Tribunal welcomed the Health and Social Care Bill saying it could lead to the denationalisation of health care services in England. He went on to become Chair of the  Health and Social Care Information Centre .
• The government uses austerity (the theft of our taxes to bail out the assets of bankers) as an excuse to begin a spending freeze (cuts to funding in real terms) for the NHS (see  Nicholson Challenge ).
•  Mark Britnell  is interviewed at a conference in New York entitled How private companies could take advantage of the vulnerability of health care systems in a harsh financial climate.
• The Commons' Health Select Committee recognises that the  internal market  has not improved patient care (indeed it was never intended to, the internal market was a prerequisite for  privatisation ), and in this regard (because of tendering, billing, accounting, chasing fees, legals costs etc. - all diverting money from front-line services) they declare it to be a costly failure.
•  Polyclinics  are put on hold.

•  NHS Property Services Ltd  is set up as a mechanism to transfer surplus land and buildings out of the NHS.
• In January Michael Portillo let slip (if it was not already obvious) Tory intentions for the NHS.
• Because of opposition to the  Health and Social Care Bill , there was a brief listening exercise in the spring and summer of 2011. This had almost no impact upon the contents of the Bill.

• The  Health and Social Care Bill  received Royal Assent and becomes the  2012 Health and Social Care Act (HSCA) 

  A survey undertaken by the Royal College of General Practitioners showed a large majority of GPs opposed the HSCA. In response  Andrew Lansley  (then Secretary of State for Health) sent a letter to all GPs, assuring them that there would be no requirement to privatise or put services out to tender. This was a lie.
• The Audit Commission warned that classifying patients for accounting purposes was wasting valuable NHS time and money, which would be better spent on the patents themselves.

• South London Health Care Trusts (SLHT) became the first NHS Trust to go bust as a result of the  Private Finance Initiative 

  See  Trust Special Administrator 
• The World Economic Forum - an international organisation that describes itself as providing a platform for the world's leading 1,000 companies - ran a project concerned with the financial sustainability of publicly provided health services, including the NHS. The project team, dominated by senior representatives from multinational corporations, was steered by  Simon Stevens . Its report co-authored by  McKinsey , suggested solutions including; lowering costs by introducing new payment systems for organisations to encourage savings, cutting services in higher cost settings such as hospitals, and getting individuals to provide more self care. At the same time, the report argued that corporations should be allowed greater access to publicly run health systems like the NHS to provide new products and services while governments cut back on publicly provided care.
•  Virgin Care  took over Assura.

• The  2012 Health and Social Care Act  comes into effect in the summer of 2013.

  The deputy chair of  Monitor  said that the new competition arrangements were a bonanza for lawyers and [management] consultants, warning that they might lead to scandals.

  The Centre for Health and the Public Interest published a report warning that greater use of for-profit providers as a result of the Health and Social Care Act is likely to substantially increase the amount of health care fraud in the NHS - specifically through overcharging.
• Early in 2013 The campaign to Save Lewisham Hospital took the government to court and got the decision by the  Trust Special Administrator  overturned.
• The  Francis Report  is published.

• Representatives of the UK's hospital doctors and sexual health specialists wrote to all local councils in England strongly advising them NOT to put services that provide contraception and diagnose sexually transmitted infections out to competitive tender. They claimed that outsourcing posed several key threats including reduced access to clinics and treatment and a reduction in the quality of patient care, adding:

  Tendering has negatively impacted on the provision of sexual health services, destabilising, disintegrating and fragmenting services, causing significant uncertainty amongst patients and staff, and reducing overall levels of patient care.

• A private hospital in Blackpool owned by Spire (a company formed in 2007 when BUPA sold their hospitals to Cinven, a private equity firm) accused the Blackpool  Clinical Commissioning Group (CCG)  of 'anti-competitive' behaviour when it failed to offer patients the choice of Spire's private hospital as well as the local NHS  Foundation Trust  hospital. It took  Monitor  a year to investigate, and it found in favour of the CCG, but said that the CCG should  promote choice  more openly when patients were offered their first inpatient appointment. If Spire had not been allowed by the new competition rules to make the accusation, then more money could have been spent on patient care rather than investigating the claim.
• An  Independent Sector Treatment Centre  owned by Carillion is taken back under NHS control following the unexpected deaths of three patients.
• A British Medical Journal article reveals that a new category of patient - called the  Self-Funding Patient  - is being introduced at an increasing number of hospitals.
• The coalition government gave a contract to treat brain tumours to  Health Corporation of America .
• A second sustainability project from the World Economic Forum took place. Again it was steered by  Simon Stevens  (amongst others) and reported again in collaboration with  McKinsey . The report this time called for a shift towards  Integrated Care Systems  such as the Alzira model developed in Spain.

•  Simon Stevens  becomes the Chief Executive of  NHS England  and publishes a five year plan for the NHS called the  Five Year Forward View .
• Tory Public Health Minister - Jane Ellison - referring to the  2012 Health and Social Care Act , tells a Tory Reform Group meeting: I don't know how much any of you realise that with the Lansley Act, we pretty much gave away control of the NHS.
• NHS England released plans to stop commissioning specialist renal services (dialysis and organ transplants), transferring the responsibility to underfunded  Clinical Commissioning Groups .
• The government began promoting  mutuals  as a business model that could replace publicly owned NHS providers. They encouraged  Foundation Trust  Hospitals to float themselves on the stock market as mutuals. The government referred to  Circle  as an example of the business model they wished to promote.
• Stuart Rose, the former head of Marks and Spencer is appointed to lead a review into how to improve management of the NHS in England (which echoes the similar and infamous invitation made to Sainsbury's Manager  Roy Griffiths  in 1983). At the same time as leading the review, Rose was paid to sit on the advisory board of Bridgepoint - an international private equity group, which is the major shareholder of private health care firm  Care UK . Care UK was in the running to take over the George Eliot NHS Hospital Trust - one of 14 hospital Trusts in Stuart Rose's review.
•  'Lord' Warner  writes a pamphlet for Reform in which he recommended charging for NHS services.
• The government faced the first national action by trade unions on NHS pay since 1982. This included the first ever strike by the Royal College of Midwives.

•  Junior doctors  began a series of strikes lasting about a year over the imposition of a new contract. As of 2018 this is the biggest UK industrial action of the twenty-first century, and has parallels with the miner's strike of the 1980s.
• Jeremy Corbyn and John McDonnell sign their support for the  NHS Reinstatement Bill .

•  Sustainability and Transformation Plans  are published.
•  NHS Property Services Ltd , now leasing land and buildings that once belonged to the NHS back to the NHS, decides to increases the rents it is charging its tenants - an additional £60-million per year with some GP practices having rent increases in order of 400 percent.
• The  British Medical Association (BMA)  leadership endorsed an amended - but unsatisfactory - contract for the junior doctors. 60 percent of junior doctors voted against it, leading to more strike action, but after a year the BMA suspended the strike action and the contract was rolled out.
•  Commissioning Support Units  are put out to competitive tender.
• PET-CT (Positron Emission Tomography - Computed Tomography) services are put out to competitive tender.
• Following a debate in the (unelected) House of Lords a committee is appointed to inquire into the long-term sustainability of the NHS. In the aforementioned debate, peers suggested a move away from a tax-funded NHS, proposing instead that the NHS should be funded by schemes such as compulsory insurance or patient charges.

• 10 pilot or shadow  Accountable Care Systems  have been implemented across England.
• On April 5th 2017 the Long-Term Sustainability of the NHS Committee published their report. Their report looks at various things, but regarding Funding the NHS and Adult Social Care they do not recommend the introduction of up-front user charges for the NHS, but they do suggest introducing a form of hypothecated charge (essentially a health insurance tax). The report plays down privatisation and the deliberate underfunding that has accompanied it.
• In October 2017 patient charges for NHS services were expanded in England. Hospitals and other providers of NHS funded treatment are now required to make sure patients in England are eligible for free care and to charge them up-front if not. There is no standard way of ascertaining whether someone is eligible for free care under the new rules. Some hospital Trusts require patients to provide two forms of ID including one proof of their residential address. This has mostly impacted people who live outside the UK, but who need medical treatment while they are here.

•  NHS England  publishes its new  NHS Long Term Plan , which proposes significant changes to the architecture of the NHS
•  Priory Group  pleaded guilty to causing the death of a 14 year old girl due to inadequate health and safety standards.
•  InHealth  are awarded a 7-year contract for PET-CT services in Oxfordshire.
• There are renewed calls for the new patient charging regime (introduced in 2017) to be scrapped after a pregnant woman who was on holiday in the UK developed complications requiring an emergency caesarean. Unfortunately her baby died, but she was subsequently handed a bill for £10-thousand. She could not afford to pay the bill, and consequently she was denied access to the deceased body of her baby.
• In a landmark case fighting against back-door privatisation via arms-length companies (such as Choices in Sunderland), 600 workers at Bradford Teaching Hospitals NHS Foundation Trust voted (97 percent) to take indefinite strike action against plans to transfer them out of the NHS and into a wholly-owned (private) subsidiary company called Bradford Healthcare Facilities Management Ltd.

• Following the failure of  Care.data  in 2014, the government tries again to place all NHS patient medical records, including those records held in GP practices, into the  NHS Digital  central database, with the aim of making the majority of medical data available to corporations.