The new Health and Social Care Bill abolishes government control of NHS trusts by turning them into foundation trusts - competing independent corporations with powers to generate income.
These powers threaten to widen inequalities, write Professor Allyson Pollock and colleagues, while safeguards to ensure that equal care is available to everyone who needs it are insufficient.
For instance, there are no duties on either foundation trusts or the independent regulator to safeguard the principles of universality and equity. Moreover, it will be the independent regulator, and not local people, who will be responsible for deciding which services are provided where and how.
Foundation trusts will be able to subcontract clinical services and staff to commercial companies. They will also be able to enter into joint ventures with companies for the sale of health care and other services including health insurance. Their new freedoms include the power to buy and sell NHS land and assets and retain the proceeds from land sales.
Foundation trusts will compete against each other for scarce NHS revenue on the basis of price, and will find themselves driven to select patients, treatments, and services on the basis of financial risk rather than healthcare needs, say the authors.
The bill will lead to multiple systems of care in England with access to and the quality of NHS provision increasingly dependent on the wealth and resources of local communities.