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, giving private companies opportunities to make profits from a tax-funded health care system and introducing inequalities in terms of access to services.
Turning the NHS into a market and privatising its services have been made easier by the Health and Social Care Act of 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. 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 demoralised staff, as well as being hugely expensive. The upheaval brought about by the Health and Social Care Act of 2012 (HSC Act) has been the worst example of this – until now.
We are again seeing a massive disorganisation of the NHS. What’s different now though, is that change happens without appearing to need legislation, public consultation, government white papers, or all the usual ways of proceeding. Instead change is brought about on the orders of NHS England (a body at arms length from the government), under the instruction of the Health Secretary, using new powers given to him by the HSC Act. As some have observed, this means two things are happening:
- the requirements of legislation about the NHS such as the HSC Act, are being ignored or changed without any consultation or formal agreement (for example the requirement of compulsory competition is increasingly being overlooked); and
- new plans that don’t fit with existing NHS legislation – such as the division of the NHS in England into 44 ‘footprints’ or Sustainability and Transformation Partnerships that must completely restructure the NHS and the delivery of 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 (like local authorities or Clinical Commissioning Groups) are having to hand over much of their authority to new organisational forms (like Sustainability and Transformation Partnerships) that currently have no formal existence or legal status. All this makes it easier for senior figures and powerful lobbying groups to exert influence behind the scenes, and for decisions about our health services 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,
- NHS England’s Five Year Forward View (2014) and The Next Steps to the Five Year Forward View (2017)
- Transformation and Sustainability and Transformation Partnerships
- Integrated or accountable care (including Accountable Care Systems and Organisations)