Chapter Seven: Creeping Privatisation? Examining Procurement Choices in the ‘New’ NHS in England

  • Vid CalovskiEmail author
  • Michael Calnan


This chapter focuses on the introduction and implementation of the Health and Social Care Act (UK Legislation 2012) in England which reignited the debate about the extent to which the government-funded National Health Service (NHS) is being privatised and/or marketised. It analyses past health service policy developments as they relate to the role of the private health sector, providing a broad sociological and policy context for the most recent legislation and considering the extent to which these represent a radical shift or an incremental policy change. The chapter draws on an ethnographic study of decision-making by the newly created Clinical Commissioning Groups about the extent to which privatisation is taking place. The central argument is that while there has been a considerable change in the commissioning apparatus, private providers have not yet made inroads into the NHS. The chapter concludes by discussing the possible long-term implications of the legislation, considering the extent to which it may have indirectly, rather than directly, encouraged a drift towards privatisation.


  1. Allen, P., Turner, S., Bartlett, W., Perotin, V., Matchaya, G. and Zamora, B. (2012). Provider diversity in the English NHS: a study of recent developments in four local health economies. Journal of Health Services Research and Policy, 17(1_suppl), pp. 23–30.CrossRefGoogle Scholar
  2. Allen, P. and Petsoulas, C. (2016). Pricing in the English NHS quasi market: a national study of the allocation of financial risk through contracts. Public Money and Management, 36(5), pp. 341–348.CrossRefGoogle Scholar
  3. Appleby, J., Galea, A. and Murray, R. (2014). The NHS Productivity Challenge. Experience from the Front Line. London: The King’s Fund.Google Scholar
  4. Calnan, M. (2000). The NHS and private health care. Health Matrix, 10(1), pp. 3–11.Google Scholar
  5. Calnan, M., Cant, S. and Gabe, J. (1993). Going Private: Why People Pay for Private Health Care. Open University Press.Google Scholar
  6. Calovski, V. (2018). The New NHS in England: Exploring the Implications of Decision Making by Clinical Commissioning Groups and Their Effect on the Selection of Private Providers. Doctoral Dissertation, University of Kent.Google Scholar
  7. Checkland, K, Harrison, S. and Coleman, A. (2009) Structural interests in health care: evidence from the contemporary national health service. Journal of Social Policy, 38(4), pp. 607–625.CrossRefGoogle Scholar
  8. Checkland, K., Dam, R., Hammond, J.O.N., Coleman, A., Segar, J., Mays, N. and Allen, P. (2018). Being autonomous and having space in which to act: commissioning in the ‘New NHS’ in England. Journal of Social Policy, 47(2), pp. 377–395.CrossRefGoogle Scholar
  9. Davies, A.C. (2013). This time, it’s for real: the Health and Social Care Act 2012. The Modern Law Review, 76(3), pp. 564–588.CrossRefGoogle Scholar
  10. Dixon, A. and Ham, C. (2010). Liberating the NHS: The Right Prescription in a Cold Climate? London: The King’s Fund.Google Scholar
  11. Flynn, R., Williams, G. and Pickard, S. (1997). Markets and Networks. Buckingham: Open University Press.Google Scholar
  12. Guest, G., Namey, E. and Mitchell, M. (2013). Collecting Qualitative Data: A Field Manual for Applied Research. Thousand Oaks: Sage.Google Scholar
  13. Ham, C., Baird, B., Gregory, S., Jabbel, J. and Alderwick, H. (2015). The NHS Under the Coalition Government. London: The Kings Fund.Google Scholar
  14. Ham, C., Dixon, A. and Brooke, B. (2012). Transforming the Delivery of Health and Social Care. London: The King’s Fund. Available at: [Accessed 7 May 2017].
  15. Harrison, S. and Ahmad, W. (2000). Medical autonomy and the UK state 1975 to 2025. Sociology, 34(1), pp. 129–146.CrossRefGoogle Scholar
  16. Hunter, D. (2016). The Health Debate, 2nd edition. Policy Press.Google Scholar
  17. Hunter, D., Erskine, J., Small, A., McGovern, T., Hicks, C., Whitty, P. and Lugsden, E. (2015). Doing transformational change in the English NHS in the context of “big bang” re-disorganisation. Journal of Health Organization and Management, 29(1), pp. 10–24.CrossRefGoogle Scholar
  18. Iacobucci, G. (2013). Majority of £1.5 bn NHS contracts go to private providers, study finds. BMJ: British Medical Journal (Online), 34.Google Scholar
  19. Iacobucci, G. (2016). More doctors are engaged in commissioning under CCGs. BMJ, 354, p. i3875.Google Scholar
  20. Klein, R. (2007). The new model NHS: performance, perceptions and expectations. British Medical Bulletin, 81(1), pp. 39–50.CrossRefGoogle Scholar
  21. Klein, R. (2013). England’s national health service-broke not broken. The Milbank Quarterly, 93(3), p. 455.Google Scholar
  22. Klein, R. (2018). The National Health Service (NHS) at 70: Bevan’s double-edged legacy. Health Economics, Policy and Law. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  23. Krachler, N. and Greer, I. (2015). When does marketisation lead to privatisation? Profit-making in English health services after the 2012 Health and Social Care Act. Social Science and Medicine, 124, pp. 215–223.CrossRefGoogle Scholar
  24. Le Grand, J. (2002). Further tales from the British national health service. Health Affairs, 21(13), pp. 116–128.CrossRefGoogle Scholar
  25. Lewis, R., Dixon, J. and Gillam, S. (2003). Future Directions for Primary Care Trusts. The King’s Fund.Google Scholar
  26. McDermott, I., Checkland, K., Coleman, A., Osipovič, D., Petsoulas, C. and Perkins, N. (2017). Engaging GPs in commissioning: realist evaluation of the early experiences of Clinical Commissioning Groups in the English NHS. Journal of Health Services Research and Policy, 22(1), pp. 4–11.CrossRefGoogle Scholar
  27. Miller, R., Peckham, S., Coleman, A., McDermott, I., Harrison, S. and Checkland, K. (2016). What happens when GPs engage in commissioning? Two decades of experience in the English NHS. Journal of Health Services Research and Policy, 21(2), pp. 126–133.CrossRefGoogle Scholar
  28. Mohan, J. (2009) Visions of privatisation under new labour. In: J. Gabe and M. Calnan (eds.) The New Sociology of the Health Service. Routledge. pp. 79–99.Google Scholar
  29. Mossialos, E., Wenzl, M., Osborn, R. and Sanark, D. (2015). International Profiles of Health Care Systems. Commonwealth Fund. Available at: [Accessed 21 Jan. 2019].
  30. Naylor, C. (2009). Briefing: Independent Sector Treatment Centres. London: The King’s Fund. Available at: [Accessed 5 Mar. 2018].
  31. NHS Commissioning Board. (2012). Procurement of Healthcare (Clinical) Services. London: NHS Commissioning Board. Available at: [Accessed 12 Feb. 2018].
  32. NHS Digital. (2012). NHS Hospitals: New Figures Suggest 11 Per Cent Increase in Procedures Carried Out by Private Sector in a Year - NHS Digital. Available at: [Accessed 3 Aug. 2017].
  33. NHS England. (2016). Mental Health » Valuing Mental Health Equally With Physical Health Or “Parity Of Esteem”. Available at: [Accessed 2 Nov. 2016].
  34. Peck, D. and Hills, B. (2000). Provider arrangements for mental health services in ‘The New NHS’. Health and Social Care in the Community, 8(5), pp. 325–335.CrossRefGoogle Scholar
  35. Peedell, C. (2011). Further privatisation is inevitable under the proposed NHS reforms. British Medical Journal, 342.Google Scholar
  36. Pettigrew, A., Ferlie, E. and McKee, L. (1992). Shaping strategic change - The case of the NHS in the 1980s. Public Money and Management, 12(3), pp. 27–31.CrossRefGoogle Scholar
  37. Pollock, A. and Price, D. (2011a). How the secretary of state for health proposes to abolish the NHS in England. BMJ, 342(mar 22 1), pp. d1695–d1695.CrossRefGoogle Scholar
  38. Pollock, A. and Price, D. (2011b). The final frontier: the UK’s new coalition government turns the English National Health Service over to the global health care market. Health Sociology Review, 20(3), pp. 294–305.CrossRefGoogle Scholar
  39. Pollock, A.M., Price, D., Roderick, P., Treuherz, T., McCoy, D., McKee, M. and Reynolds, L. (2012). How the Health and Social Care Bill 2011 would end entitlement to comprehensive health care in England. The Lancet, 379(9814), pp. 387–389.CrossRefGoogle Scholar
  40. Saltman, R. (2003). Melting public-private boundaries in European health systems. The European Journal of Public Health, 13(1), pp. 24–29.CrossRefGoogle Scholar
  41. Shaw, E. (2003). Privatisation by stealth? The Blair government and public-private partnerships in the National Health Service. Contemporary Politics, 9(3), pp. 277–292.CrossRefGoogle Scholar
  42. Smith, J., Mays, N., Dixon, J., Goodwin, N., Lewis, R., McClelland, S., McLeod, H. and Wyke, S. (2004). A Review of the Effectiveness of Primary Care-Led Commissioning and Its Place in the NHS. London: The Health Foundation.Google Scholar
  43. Smith, P., McKeon, A., Blunt, I. and Edwards, N. (2014). NHS Hospitals Under Pressure: Trends in Acute Activity Up to 2022. London: Nuffield Trust.Google Scholar
  44. The King’s Fund. (2013). Changes to the Health and Social Care Bill: Competition. Available at: [Accessed 22 Aug. 2018].
  45. The King’s Fund. (2015). Commission on the Future of Health and Social Care in England: The UK Private Health Market. London: The King’s Fund.Google Scholar
  46. The King’s Fund. (2017a). Public Satisfaction with the NHS. Available at: [Accessed 10 May 2017].
  47. The King’s Fund. (2017b). Trusts in Deficit. Available at: [Accessed 10 May 2017].
  48. Timmins, N. (2012). Never Again? The Story of the Health and Social Care Act 2012. London: The Institute for Government.Google Scholar
  49. Timmins, N. (2018). ‘The World’s Biggest Quango’: First Five Years of NHS England Kings Fund. Institute for Government.Google Scholar
  50. Tuohy, C.H. (2018). Remaking Policy: Scale, Pace and Political Strategy. Toronto: University of Toronto.Google Scholar
  51. Turner, D. and Powell, T. (2016). NHS Commissioning Before April 2013. London: House of Commons Library.Google Scholar
  52. UK Legislation. (2012). Health and Social Care Act2012.Available at: [Accessed 18 May 2017].
  53. Virgin Care. (2017). Virgin Care - Virgin Care Provides NHS and Local Authority Services Across England with a Difference Virgin Care. Available at: [Accessed 21 Apr. 2017].
  54. Williams, I., Brown, H. and Healy, P. (2018). Contextual factors influencing cost and quality decisions in health and care: a structured evidence review and narrative synthesis. International Journal of Health Policy and Management, 7(8), pp. 683–695.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2020

Authors and Affiliations

  1. 1.School of Social Policy, Sociology and Social ResearchUniversity of KentCanterburyUK

Personalised recommendations