In 1997 Labour was elected to save the NHS. It came into power after a failed reorganisation, a long period of gross underfunding, general hostility to the public sector and an alienated workforce. Familiar?  Labour saved the NHS but never reversed the fundamental changes made by the Tories.

The Thatcher attack on public services was most muted in relation to healthcare. Compulsory Competitive Tendering had applied for non-clinical services but not more widely. Some attempts to introduce management and accountability had largely failed. The consensus model clung on. The view was clear though – the NHS was inefficient, oblivious to customer need, run for vested interests not for patients and impervious to change. Almost in desperation they launched the biggest reorganisation ever, based on the ideological view that choice competition and markets were what was needed.

The changes, as with all others, was opposed by the professions and partly due to their lack of engagement the reforms did not really happen. There was all the cost and upheaval of structural change but no benefits. Familiar?  Labour attacked the moves to markets and privatisation. Familiar?

Anyway Labour did not reverse the core policy shift to an internal market or wind back the reorganisation which gave us the purchaser provider split. It first had to deal with day to day realities of a service under huge pressure in the political spotlight. Familiar?  Labour’s key aim was to reduce waits; by far the biggest concern of patients. It focused on restoring staff morale, building capacity, encouraging PPI, inventing regulation. It used targets and terror as its preferred tool for change.

By the mid noughties it was clear faster progress was necessary and the usual frustration at what was perceived as obduracy from vested interests was confronted; once again competition and choice gained ground. By the end of the Labour period it was clear there were now strategic problems caused by the tactical use of private sector (Private Finance Initiative, Independent Sector Treatment Centres, Any Willing Provider, Transforming Community Services) and we saw the beginnings of reversal with preferred provider.  But Labour went into 2010 without the NHS as a major issue and there was no promise for the NHS plan to be renewed.

Most evidence agreed that the NHS Plan succeeded, as waits came down to levels previously thought impossible, satisfaction was at highest ever; Public and Patient Involvement was here to stay, and we had some independent regulation. Still in 2010 there were new concerns; collapse of social care, weak commissioning, weak tokenism of Public and Patient Involvement, the dominance of the outdated clinical model of care and no democratic accountability. After 13 years the NHS was still an island separated from rest of public service, fragmented and poorly managed. Familiar?

Anyway we then had the Lansley attack, the regulated market, a huge reorganisation and the championing of the private over the public (with Circle leading the way!).  This was combined with austerity and funding cuts and the almost total collapse of social care.  Probably the worst period ever for the NHS and for any notion of a caring society.  If the Tories win in 2015 we can wave goodbye to the NHS as we know it.

When it takes over in 2015 it will be a lot like 1997 with an urgent need to bring stability, to restore morale and to give a sense of direction – huge immediate problems.  Once it fixes the crisis does Labour do the pragmatic as last time or does it tackle real issues as Tories tried to do in 1990. Does ideology prevail? Have we at last seen the end of the era of markets and competition, outsourcing and privatisation?

There are constraints to be sure.  The Tories promised no reorganisation but did one anyway but Labour won’t. That is good and bad.  More money is promised but it won’t be enough.

Still emerging new ideas gives hope. Whole person care is a powerful idea. Labour has dusted off idea of having a long term plan; pledged to get rid of market and enforced competition. It will be putting in more funding and has identified the sources. Public Health and Mental Health are being spoken about! It has accepted social care issues are really important. It looks like at last we will be bringing NHS in from the cold, albeit into cash strapped and neutered local authorities. At least there is thinking about democratic accountability, free social care, shared decision making, coproduction, community development, social model for care and integration.

Maybe this time. Fingers crossed. Phasers on stun.

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2 Comments

  1. 12 January 2015
    Dear Mr Brown
    I am grateful to you for your insights and wish to make a couple of observations please.
    1] Why was the “National” Health Service disbanded at all? We no longer have a single “National” Health Service.
    2] Why does each nation have its own “National” Health Service NHS which is totally different from that which was set up and operated by the Labour Government in post-war Britain?
    I would be most grateful for your answers as I am making serious enquiry as to what happened to the BRITISH National Health Service that served the entire UNITED KINGDOM from centralised Government ministry and civil service.
    Thank you very much.
    Rosemary Cantwell

  2. “The Thatcher attack on public services was most muted in relation to healthcare. Compulsory Competitive Tendering had applied for non-clinical services but not more widely. Some attempts to introduce management and accountability had largely failed. The consensus model clung on. The view was clear though – the NHS was inefficient, oblivious to customer need, run for vested interests not for patients and impervious to change. Almost in desperation they launched the biggest reorganisation ever, based on the ideological view that choice competition and markets were what was needed.”

    Clearly people today get lost in the Neo-Liberal market terminology and do not understand that economics as taught in our universities does not reflect what is actually happening on the ground, hence students are now setting up their own study centres to provide the necessary background information they need to make real assessments of the world they live in.

    Thatcherite dogma is Neo-Liberalism and bears no resemblance to the needs of people but a means to transfer wealth and power upwards.

    Adam Curtis has recently made a film showing how politicians use chaos as a means of public control, (constant change for change sake), this then allows them to pursue policies that are against the public interest that people would normally; http://www.bbc.co.uk/blogs/adamcurtis

    The truth that most seem unable to comprehend is that the Neo-Liberal agenda uses finance created out of thin air to protect the financial assets of the rich against the needs of people, that is what has to change.

    We have the money for our public services, we can spend unlimited sums
    to fund our infrastructure, the only thing we don’t have is a government with the will to do it, all the major parties are lying to us when they say we have a deficit problem, or that the country is broke, both statements are factually wrong.

    People need to understand that, it is fact.

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