NHS leaders want Theresa May to scrap Conservative legislation that forces the tendering of contracts for care, in a move which could dramatically reduce privatisation of key health services.

In the latest long-term plan, which maps out the NHS’s future over the next 10 years, Simon Stevens, the chief executive of NHS England, demands that the prime minister repeals significant key sections of the Health and Social Care Act 2012.

The document, which Downing Street has endorsed, warns that the legislation, which was pushed through by the then health secretary, Andrew Lansley, despite huge opposition, is damaging the NHS and stopping it from making vital improvements to the care patients receive. It outlines how Lansley’s shake-up has damaged the NHS, which May has previously acknowledged.

If she agrees to unwind some of the most contentious sections of the act, it would mean “the end of automatic tendering” in the health service, said a senior NHS source. It would also means that firms such as Virgin Care, which has won more than £2bn in contracts from the NHS over the last five years and holds more than 400 of them, could no longer mount a legal challenge to a decision that went against the Richard Branson company.

The 2012 act obliges NHS clinical commissioning groups (CCGs) in England to tender out any contract worth £615,278 or more. This has led to a huge increase in the number of NHS contracts awarded to profit-driven firms such as Virgin Care and Care UK.

An estimated £8.7bn of the health service budget went to non-NHS providers of care in 2017-18. Most were private firms; the rest were charities and social enterprises. NHS bosses want the service taken out of the public contract regulations that underpin the tendering regime.

The long-term plan, which set out how the NHS will use the £20.5bn a year funding increase May pledged last year, includes moves to improve every area of physical and mental health care, such as:

Offering millions of patients online consultations with their GP via videolink software such as Skype, instead of face-to-face appointments in an effort to ease the pressure on family doctors.

One in three patients receiving care from newly enhanced community-based services rather than going to their local hospital for an outpatient appointment, which accounts for 30m clinic visits a year.

More money to help narrow stark inequalities in the health and life expectancy between wealthy and poor people.

Recruiting more staff from abroad in order to minimise the damaging impact of chronic NHS understaffing, which it says is “unsustainable”.

However, Stevens admitted NHS England was considering relaxing long-established key treatment waiting time targets, including hospitals’ duty to deal with 95% of A&E patients within four hours.

The 133-page document says NHS bosses have drawn up “a provisional list of potential legislative changes for parliament’s consideration” following invitations to do so from May and MPs on the health and social care select committee. If enacted, these changes would “remove the counterproductive effect that general competition rules and powers can have on the integration of NHS care”, the document adds.

“The 2012a ct creates some barriers to ICSs [integrated care systems] being able to consider the best way of spending the total ‘NHS pound’,” says the document, referring to integrated care systems the proposed as the future model for the health and care system in England’s 44 NHS areas. Repealing the most contentious sections of the legislation would also “cut delays and costs of the NHS automatically having to go through procurement processes”.

Stevens and fellow service leaders who wrote the document want CCGs, either acting alone or in groups such as in an ICS, to be able in future to apply a new “best value” test that would be designed “to secure the best outcomes for patients and the taxpayer”. That test would let CCGs decide who should be awarded the contract, without fearing that they may be sued by a private firm which had seen its tender rejected. Virgin Care has come under heavy criticism for suing the NHS after a failed bid.

Allies of Stevens say that the long-term plan shows that NHS campaigners have been wrong to depict him as someone who has been presiding over a sell-off of NHS care.

Sources close to Stevens stressed that the widespread fragmentation of care delivery brought about by privatisation had to end because it ran contrary to NHS England’s drive – backed by the government – to integrate health and care services over the next few years so that patients receive a simpler, more streamlined service.

Stevens has previously sought to reassure ministers that revisiting the 2012 act should not necessitate a further shake-up of how the NHS is organised and that well-judged changes would suffice. “I don’t think most people in the health service want to see another top-down reorganisation with all the cards thrown up. What people are interested in are carefully targeted adjustments to the framework,” he told the parliamentary magazine the House last year.

Jon Ashworth, the shadow health secretary, said: “The fact NHS bosses are now proposing significant changes to the Health and Social Care Act confirms what a wasteful, bureaucratic disaster it was in the first place.”

“Labour have long called for this act to be binned and will study legislative proposals carefully. The Tories must apologise for wasting billions of taxpayers’ money on the privatisation, constant tendering of contracts, top down reorganisation and demoralisation of staff this Tory act ushered in.”

Dr Chaand Nagpaul, the chair of the British Medical Association, urged May to heed the NHS leaders’ plea. “When government rhetoric is centred around integration within the health service, independent providers bidding on time-limited contracts sits entirely at odds with this philosophy,” he said.

“Only by removing the requirement to put service out to tender, can local systems work together to ensure cohesive patient-centred healthcare.”



