The NHS & Social Care White Paper is a charter for a privatisation bonanza: Hancock’s game of thrones & how to resist.


“Private providers commissioning themselves? Forget the Serco Track & Trace scandal; we’re crossing the Rubicon.”

Ruth Milsom

By Ruth Milsom, Labour candidate for Crookes & Crosspool ward in Sheffield.

“A more integrated, more innovative and more responsive system, harnessing the best of modern technology and supporting the vocation and dedication of those who work in it.” Secretary of State for Health & Social Care Matt Hancock’s summary of his White Paper, as he introduced it to Parliament in February.

Sounds good? Integration = efficiency; innovation = progress; responsiveness = patient-centred administration.

But this is not a government that has repented overnight its marriage commitment to marketisation.

Successful marketisation depends upon centralised control. If your ideological modus is command of the flow of public money to private coffers, you won’t tolerate rogue practices like hyper-localised needs-based commissioning. At the same time you must keep up the facade; the Public must believe that healthcare decisions are a local affair directed by health professionals and elected representatives who know the requirements of the place they serve.

This White Paper paves a yellow-brick road to the fulfilment of a meticulously pre-meditated post-Thatcher Tory dream. Phase one – the ConLib coalition’s 2012 Health & Social Care Act – solidified the NHS internal market and tendering to private profiteers, whilst repealing the Secretary of State’s responsibility for providing universal healthcare. Phase two concentrated on de-funding, de-staffing, and demoralising; the success of those programmes is plain to see – 100,000+ staff vacancies in the NHS; care workers run ragged for poverty pay; private providers ‘stepping in’ to plug consciously fabricated insufficiencies and turn their profits – softly, softly bringing us round to acceptance of the ‘necessary’ interference of private enterprise in our greatest public institution. Desensitisation.

This next phase is about proto-totalitarian control behind a mask of accountability. Integrated Care Systems (ICS) have been subtly phased in as shadow commissioning organisations, covering large geographic areas. In early 2018 Stephen Hawking and leading doctors took Jeremy Hunt to court to argue that Accountable Care Organisations (ACO) were illegal; but Hunt simply changed the moniker to ‘ICS’ and let it all blow over. Now in April 2021, ICSs receive legal commissioning status. Partners on ICS boards will include local authorities (a token of public accountability), but place-based Clinical Commissioning Groups lose their direct control over what services are available locally. As a sidenote, Hancock announces that social care commissioning (hitherto fully in local council control) will slip quietly into the ICS portfolio.

And here’s a Fun Fact: any third-sector or independent provider may sit on an ICS board. Private providers commissioning themselves? Forget the Serco Track & Trace scandal; we’re crossing the Rubicon.

Hancock reassures us on accountability: “NHS England will have clinical and day-to-day operational independence”; but in the same breath, “the Secretary of State will be empowered to set direction for the NHS and intervene where necessary.” Ministers have power to intervene at any point on the opening and closing of NHS services – a toxic confusion of party politics and ‘independent’ local decision-making.

I’m preaching to the choir; but this choir’s words and actions can effect change. Through the dedicated work of bodies like the Socialist Health Association along with campaign groups up and down the country, our Labour Party has committed itself to de-privatising healthcare and creating a National Care Service fit for purpose when next in government.

If we fight, we can win.

  • Ask your council to denounce the White Paper publicly for its side-lining of local authorities in holding NHS England to account.
  • Join your local NHS campaign group.
  • Stand in solidarity with Nurses United and NHS Workers Say No in the #NHSPay15 campaign.
  • Become a local Healthwatch member; ask the ‘awkward’ questions and challenge NHS England management from within the ‘system’.
  • Don’t wait for a Labour government. Get on the campaign trail now with your Labour candidates in the local elections, and ensure Labour holds power in every ICS locality.

Ruth Milsom is the Labour candidate for Crookes & Crosspool ward in Sheffield, Secretary of the Socialist Health Association’s Yorkshire branch, and Secretary of Sheffield Save Our NHS.


Hancock’s statement 11 Feb 2021:

Govt press release 11 Feb 2021:

Stephen Hawking and leading doctors take Hunt to court over ACOs:

Socialist Health Association Motion to Labour Conference 2018:

Health Campaigns Together:

NHS Workers Say No:

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