These were Conservative pledges before the 2010 election. But while the public was being reassured about the future of the NHS, the Conservative Party was carrying out long-standing plans, spearheaded by Oliver Letwin and John Redwood and dating from the 1980s, to undertake the largest top-down re-organisation of the NHS since its inception. This included opening it up to private healthcare companies and shifting it towards a US-style system based on private health care insurance (see for example, http://liberalconspiracy.org/2011/06/03/revealed-the-pamphlet-underpinning-tory-plans-to-privatise-the-nhs/, plus our page on The Long Term Plan).
In 2004 Oliver Letwin was reported to say at a private meeting with representatives from the construction industry that “the NHS will not exist” within five years of a Conservative election victory. Instead the NHS would be a “funding stream handing out money to pay people where they want to go for their healthcare” (http://www.independent.co.uk/life-style/health-and-families/health-news/letwin-nhs-will-not-exist-under-tories-6168295.html).
The Coalition government brought about many of the ‘reforms’ proposed in the Letwin/Redwood plan, through its Health and Social Care Act of 2012. But by the autumn of 2014, as it was becoming clear that the NHS was becoming one of the key issues for the 2015 general election, attempts were made to distance the Prime Minister and the Chancellor from the ‘reforms’. Downing Street sources suggested that the massive restructuring of the NHS had been a mistake and that the plans drawn up by the Health Minister, Andrew Lansley, had been his and his alone: “No-one apart from Lansley had a clue what he was really embarking on, certainly not the Prime Minister.” (see The Times, October 13th 2014, pages 1 & 2.). What a tangled web we weave …. (see for example, http://www.telegraph.co.uk/health/healthnews/9095923/David-Cameron-Health-Secretary-Andrew-Lansley-has-my-full-support-over-NHS-reforms.html.)
Prior to the 2015 election there were again assurances from the Conservative party that the NHS was safe in their hands. These coincided with the introduction of the Five Year Forward View by NHS England, which aimed entirely to restructure the NHS again, this time by integrating different services into new ‘models of care’ (similar to Accountable Care Organisations in the US). Although this reorganisation is described as locally led rather than being imposed top-down, the development of new models of care will be closely monitored, if not guided, by NHS England and, arguably, bring about the gradual transformation of the NHS into an insurance-based health care system – the last stage of the Letwin/Redwood plan described above. (see also our page on the Five Year Forward View) .