The proposals in the act were not discussed during the 2010 United Kingdom general election campaign and were not contained in the Conservative–Liberal Democrat coalition agreement of 20 May 2010,[1] which declared an intention to "stop the top-down reorganisations of the NHS that have got in the way of patient care".

Primary care trusts (PCTs) and strategic health authorities (SHAs) were abolished, with projected redundancy costs of £1 billion for around 21,000 staff.

The bill also abolished the existing cap on trusts' income from non-NHS sources, which in most cases was previously set at a relatively low single-digit percentage.

[14] After an increase in opposition pressure, including from both rank-and-file Liberal Democrats and the British Medical Association, the government announced a "listening exercise" with critics.

[16][17] The Prime Minister, David Cameron, said "the status quo is not an option" and many within his and Nick Clegg's coalition said that certain aspects of the bill, such as the formation of Clinical commissioning groups, were not only not open for discussion, but also already too far along the path to completion to be stopped.

"[22][23] KPMG issued a press statement on behalf of Britnell on 16 May 2011 stating "The article in The Observer attributes quotes to me that do not properly reflect discussions held at a private conference last October.

[24] The Future Forum report suggested that any organisation that treats NHS patients, including independent hospitals, should be forced to hold meetings in public and publish minutes.

The original bill sought to abolish two tiers of management and hand power to new bodies led by GPs, called commissioning consortia, to buy £60 billion a year in treatment.

Professor Steve Field, a GP who chaired the forum, said many of the fears the public and medical profession had about the Health and Social Care Bill had been "justified" as it contained "insufficient safeguards" against private companies exploiting the NHS.

Sections 181 to 189 establish Healthwatch England, responsible for gathering and championing the views of users of health and social care services in order to identify improvements and influence providers' plans.

[33] The Confederation of British Industry supported the bill, declaring that "Allowing the best provider to deliver healthcare services, whether they are a private company or a charity, will spur innovation and choice.

[35] On 14 May 2011, The Guardian published an article reporting that the GP appointed to head the NHS "listening exercise" has unilaterally condemned the bill.

We did it in gas, we did it in power, we did it in telecoms […] We've done it in rail, we've done it in water, so there's actually 20 years of experience in taking monopolistic, monolithic markets and providers and exposing them to economic regulation.

The Royal College of General Practitioners said it was "concerned that some of the types of choice outlined in the government's proposals run a risk of destabilising the NHS and causing long-term harm to patient outcomes, particularly in cases of children with disabilities, those with multiple comorbidities and the frail and elderly.

"[34] The Royal College of Surgeons said that "the legislation leaves the question of regional level commissioning unanswered with no intermediary structure put in place.

The BMJ wrote that "No matter how many GP consortiums eventually emerge, their number will probably greatly exceed the 152 primary care trusts they are replacing, which brings a set of new challenges.

Denied economies of scale, smaller consortiums may be tempted to cut corners on high quality infrastructure and management, thereby endangering their survival.

Some groups had severely underestimated the importance of high quality professional management support in their early days and gone bankrupt as a result.

Those close to Health Secretary Andrew Lansley have said that he is concerned adding too many people to consortia decision-making risks making them too unwieldy.

"[1][43] Kieran Walshe, professor of health policy and management and Chris Ham, chief executive of the King's Fund, argued that "At a national level, it is difficult to see who, if anyone, will be in charge of the NHS.

[45] The King's Fund said that "the very real risk that the speed and scale of the reforms could destabilise the NHS and undermine care must be actively managed.

[48][49] "People will die", Richard Horton, editor of The Lancet, warned in March 2012, as he predicted "unprecedented chaos" as a result of the reforms,[50] with a leaked draft risk-assessment claiming that emergencies could be less well managed and the increased use of the private sector could drive up costs.

[53] In March 2011 a motion at the Liberal Democrat spring conference called for changes to the Bill to ensure greater accountability and prevent cherry-picking by private providers, among other demands aimed at reducing marketisation of the NHS.

[55] UNISON sponsored rapper NxtGen to create an unflattering hip hop track about the bill,[56] which as of June 2011[update] had been viewed over 390,000 times on YouTube.

[59] The deputy chairman of the British Medical Association, Kailash Chand, said "Jeremy Hunt is new Health Secretary – disaster in the NHS carries on.

[61] On 5 March 2012, the campaign group 38 Degrees erected 130 billboards in the centre of London with the aim of persuading David Cameron to abandon the bill.

Their conclusions as far as the act was concerned were that: In November 2017, Jeremy Hunt in an interview with the Health Service Journal said "The idea of lots of competing foundation trusts and payment by results works well when you have in your mind that most of the work the NHS does will be single episode elective care, but when you're dealing with complex patients who are going in and out of the system a lot those structures prove not to be fit for purpose.

[66] David Benbow argued in 2020 that the legislation did not extend patient choice as envisaged (as this policy subsequently took a backseat) but that it did lead to an increasing amount of the NHS budget being diverted to private providers.

[69] A report on the state of the NHS following the election of a Labour government in 2024, commissioned by Health Secretary Wes Streeting, led by the surgeon and former member of a Labour government Lord Ara Darzi (currently an independent peer) concluded that "The Health and Social Care Act of 2012 was a calamity without international precedent – it proved disastrous.