Is a new NHS reforms row brewing?

Nurse Changes to the NHS come into force on 1 April

Grumblings of disquiet are nothing new in politics. But when they involve the government's NHS reforms the scope for trouble is heightened - as the latest spat illustrates.

Over the past few days there has been mounting concern about regulations 257.

The document, which was laid before parliament on 13 February, covers the procurement of health services in England.

It may sound pretty dry, but to the government's critics it is a blueprint for privatisation.

Ministers of course deny this. David Cameron was even drawn into the debate on Wednesday, defending the regulations as amounting to nothing more than what Labour was doing when it was in power.

That, you may remember, is the same argument as the one which the government put forward when its reforms first hit the buffers two years ago.


What has caused the problem is the way the regulations are worded.

It uses phrases such as all providers must be treated equally "particularly on the basis of ownership" and contracts can only be awarded without competition for "reasons of extreme urgency".

That has prompted both Labour and the Lib Dem MPs to express concern that assurances ministers gave at the height of the controversy last time that there would not be unfettered competition are being broken.

What regulations 257 say

  • Providers should be treated equally in particular on the "basis of ownership".
  • But equally commissioners must make sure any changes ensure services are being provided in an integrated way.
  • Contracts can be awarded without competition, but only under strict circumstances.
  • These include for technical reasons or because they can only be provided by one provider as well as for reasons of "extreme urgency".
  • Commissioners must not engage in anti-competitive behaviour which is against the interests of patients.
  • They should not include any restrictions on competition that are "not necessary".

For the government, still bruised from the reforms' difficult passage through parliament, it is a sensitive issue.

So why risk a new controversy now - just a month away from the new system going live on 1 April?

The regulations were laid as part of the mopping up exercise following the passage of the Health and Social Care Act.

Procurement of health services are currently governed by primary care trusts.

But as these are being abolished new rules and guidelines are needed for the GP-led groups which will be replacing them. These are them.

In some respects they are little different from the regulations that proceeded them. Services will still be allowed to be tendered without any competition - if they are deemed a core service such as an A&E unit.

The regulations also stress the need for ensuring services are integrated and that benefit to patients remain the guiding principle.

But it is the passages that refer to when contracts are tendered out to the market that is at the heart of this.

While publicly the government is maintaining competition is not being given free rein, there is an acceptance behind the scenes that some of the language used in the document has not been helpful.

It is understood that the rewording of some of the more colourful parts is being considered in an attempt to offer some "reassurance".

If that happens it is unlikely to be enough to appease the most strident critics, but what ministers will be hoping is that it stops the grumblings becoming an avalanche of criticism.

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

Savile: Why the risks are real in today's NHS

Jimmy Savile's abuse on NHS premises spanned 44 sites. Most of the cases were decades ago, but how safe is the health service now?

Read full article

More on This Story

More from Nick


This entry is now closed for comments

Jump to comments pagination
  • rate this

    Comment number 403.

    Stafford Hospital was responsible for the preventable deaths of many hundreds of patients and considerable suffering of countless others. Yet nobody was sacked / jailed!

    Only now, 5 years on, with revenues down 67%, have administrators been called in. Yet again nobody sacked!

    Many of those responsible have even been promoted!

    Utterly scandalous!

    Yet par for he course within the NHS!


  • rate this

    Comment number 402.

    Bastiat, who cares? The unions helped a lot of the protests in the past, as well as CND, and the churches. Your dogma comes from as much fear as we all have, if not more. We need to get out there, not to loot or riot, but to know we're not to having to wait idle, scared and alone for one useless vote every four years. Democracy fails because too many people stopped caring enough to be vigilant.

  • rate this

    Comment number 401.

    398. Crow
    38degrees Are socialists.

    396. Eddy from Waring
    395. Get_the_Tories_Out
    394. shivvy
    For profit is good. It rewards good services or products - creating an incentive to improve & compete. See comment 390.

    393. All for All
    Incoherent babble.

  • rate this

    Comment number 400.

    If healthcare provided at a reasonable cost in a well regulated way at a high standard all paid for by taxes, does it matter who the provider is?

    Too many people with a one eyed view of the nhs. It's a good provider of healthcare, but it isn't the panacea. It can be better. If that requires private providers to make it better so be it

  • rate this

    Comment number 399.

    If you haven't done so already please sign the petition calling for a full debate in Parliament.


Comments 5 of 403


Features & Analysis

BBC Future

(Getty Images)

What it’s really like to die

The seven experiences you face at the end


  • Former al-Qaeda double agent Aimen DeanHARDtalk Watch

    Islamic State is about revenge says former al-Qaeda member turned spy Aimen Dean

Copyright © 2015 BBC. The BBC is not responsible for the content of external sites. Read more.

This page is best viewed in an up-to-date web browser with style sheets (CSS) enabled. While you will be able to view the content of this page in your current browser, you will not be able to get the full visual experience. Please consider upgrading your browser software or enabling style sheets (CSS) if you are able to do so.