What’s your experience of market-driven reforms?

If you want a clearer insight into the government’s current thinking on the future of England’s health service, you could do no better than to read Necessity not Nicety

This is the title of a recent Department of Health document which sets out the commercial operating model for the NHS of the future. It outlines plans to create new “commercial support units”, assisted by a “Strategic Market Development Unit”, and states firmly that “commissioners need commercial skills to be able to carry out market analyses [and] shape and nurture innovative services and new markets in healthcare.”

None of this is particularly surprising; the document is a stark example of the government’s confidence in pushing forward its commercialisation agenda. Unchallenged by any of the main opposition parties, it does not hesitate in presenting private sector involvement in our NHS as not only inevitable but also of unquestionable benefit. It believes that the argument for this development has been successfully made and universally embraced.

This view is not one shared by the BMA. Many doctors are worried about their local departments being financially destabilised by exposure to competing private providers, who are frequently being given preferential status in tendering processes. If we allow the commercialisation agenda to further take root, the effects could be even more dramatic. The incentive for private providers to invest in medical education remains disturbingly unclear. We face the prospect of an NHS where generating profits for shareholders takes precedence over delivering the best care for patients.

The BMA believes that now is the right time for us to challenge the political orthodoxy on commercial provision in the NHS. The global economic crisis will put the NHS under enormous pressure. Funding increases will not continue at the rate to which we have grown accustomed, and services are likely to be squeezed as SHAs come under pressure to contribute to the £2.3 billion worth of efficiency savings that the NHS is being asked to make. Now is the right time for us to expose the fallacies in the assumption that commercialisation equates with efficiency.

The creation of the new commercial support units itself will cost £20 million of taxpayers’ money. A recent BMJ paper suggested that the NHS in England may have overpaid the first wave of ISTC by as much as £927 million for contracted work which was not actually carried out (BMJ 2009;338:b1421). 

PFI initiatives in the NHS will cost the taxpayer billions of pounds over the coming years. We intend to show that the commercial provision of services is not a necessity. Rather, that ending this costly flirtation with private sector involvement in the NHS is the real priority.

The BMA’s Look After Our NHS campaign has been set up to gather together evidence of the true cost of market-driven reforms, the waste of public money, and the negative impact this has had on patient care. You can tell us about your experiences of NHS reforms by emailing us at [email protected] or visiting

You’ll also find on the website a set of principles that set out our vision for a publicly funded, publicly provided, publicly accountable NHS. Tell us about your concerns, share your experiences with us, and let us stand up for and look after an NHS led by healthcare professionals who put patients before profits.

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