The NHS used to be more than a means of delivering health care.
However, the NHS has undergone massive – and increasingly rapid – changes in recent years. These changes have been described by the governments that have introduced them as ‘reforms’, implying that they are about improving the NHS. Yet many of the changes are destroying the NHS as a reflection of social solidarity by turning it into a competitive market, privatising the way that healthcare services are planned, purchased and delivered and giving private companies opportunities to make profits from a tax-funded health care system.
Turning the NHS into a market and privatising its services have been made easier by the Health and Social Care Act (2012), but have also been part of a long-term plan for radical transformation of the NHS that can be traced back at least to the 1980s. Although never discussed in Parliament or put to the electorate, nonetheless elements of this plan have been – or are still being – gradually implemented by successive governments, such as
- establishing the NHS as an independent trust, largely free from central government control;
- increasing the use of joint ventures between the NHS and the private sector;
- extending the principle of charging patients for services;
- introducing a system of ‘health credits’; and
- replacing an NHS that is funded from taxation with a healthcare insurance scheme.
Not entirely separate to this, the NHS has suffered repeated, top-down reorganisations (or ‘disorganisations’) about once every two years for the past 30 years. These have largely failed to deliver their claimed benefits, have usually damaged the way services have been delivered, and been hugely expensive. The upheaval brought about by the Health and Social Care Act of 2012 (HSCA) is probably the worst example of this and, despite the mess it’s left, has dampened appetite for further legislation.
However, organisational change continues apace. What’s different now though, is that change happens without appearing to need public consultation, government white papers, statutory instruments or all the usual ways of proceeding. Instead change is brought about on the orders of NHS England, under the instruction of the Health Secretary, using new powers given to him by the HSCA. According to some, this means two things are happening:
- the requirements of legislation about the NHS, like the HSCA, are being ignored or changed without any consultation or formal agreement; and
- new ideas that don’t arise from NHS legislation – such as the creation of 44 ‘footprints’ that must develop Sustainability and Transformation Plans to completely restructure the NHS and the way it delivers care – are being implemented anyway.
As a result, it’s difficult to know who’s in charge, who’s accountable, and whether organisations are doing their job properly. Some organisations with statutory duties are having to hand over much of their authority to new organisational forms (like the ‘footprints’) that have no formal existence. All this makes it easier for senior figures and powerful lobbying groups to exert influence behind the scenes, and for decisions to become less transparent.
For details of perhaps the most significant of recent changes and their implications, see our pages on:
- The Health and Social Care Act of 2012, and
- NHS England’s Five Year Forward View (2014) and Sustainability and Transformation Plans.