Guest Editorial > Review of ‘NHS-SOS – how the NHS was betrayed – and how we can save it’ eds. Jacky Davis & Raymond Tallis; and Never Again? The story of the Health and Social Care Act 2012 by Nick Timmins
Review of ‘NHS-SOS – how the NHS was betrayed – and how we can save it’ eds. Jacky Davis & Raymond Tallis; and Never Again? The story of the Health and Social Care Act 2012 by Nick Timmins | Roger Steer
NHS-SOS –how the NHS was betrayed- and how we can save it’ eds. Jacky Davis & Raymond Tallis, Oneworld publications, London 2013 £8.99, and,
‘Never Again? The story of the Health and Social Care Act 2012’ by Nick Timmins, Kings Fund and Institute of Government 2013 Free Download
The title of the Timmins book and the tone of NHS-SOS conjure the image of the post-WW1 battlefield when, after all the bangs and crashes, the lull that follows hastens the reflection – what was all that about? So it is with the battle for the Health and Social Care Act 2012 as we wallow in the sentimentality of celebrating the 65th anniversary of the NHS.
We are left to ponder whether Lansley’s baby, six and a half years in gestation as Timmins makes clear, driven through hails of flack into the delivery suite and handed to Jeremy Hunt shortly after its delivery, with the father continuing as a hovering, glowering presence as the first precocious steps are taken, is the spawn of the devil, as portrayed by ‘NHS–SOS’ or merely a continuation of all efforts to date to leverage private sector resources into an NHS starved of resources by successive Treasury ministers, whichever party is in power. It seems that not only is the NHS a battleground for the allocation of internal resources but a battleground for the expansion of healthcare resources with much at stake for a wide range of vested interests.
The trick that Lansley has attempted to pull off is to institute a once and for all paradigm shift. Politicians have withdrawn from proximity to the battlefield; GP-led commissioners are to hold the blame for the big purchasing decisions into the future; and providers are invited to become autonomous players in a new healthcare market with the freedom to enter partnerships and increase gearing in a light touch regulatory space where user charges, appropriation of the estates of older people and offers of private healthcare you would be unwise to refuse will both resolve the perennial underfunding of the NHS and introduce the extra investment from the private sector so many of its sponsors are desperate to achieve.
NHS–SOS, on the other hand, portrays the NHS as a unique and precious social institution that has been assaulted by hostile forces that Lansley has, in an act of betrayal, let into the citadel through the back gates. Ken Loach draws the lines clearly: NHS good; Privatisation bad, and anyone who thinks otherwise is a traitor. The rest of the authors expand on this theme with a major focus on the skirmishes involved in the passing of the 2012 Act. It is a mixed bag of articles reflecting the differing backgrounds and differing roles played by the writers in the events of the last three years. Its tone throughout is still set by the theme of betrayal (or if you prefer active collusion, passive acquiescence and incorporation) by politicians, journalists, unions and the leaders of the medical profession. Be prepared for heavy artillery with phrases such as ‘Lansley’s nightmare vision’, ‘pervasiveness of corruption’, ‘debased state of national debate’, ‘marginalisation of professions’, and ‘greed was the spur’.
Raymond Tallis sets up the book nicely by posing the following questions:
- Does it matter? Here Pollock and Price give the evidence that privatisation once initiated will be irreversible, claiming that there will be ‘both expansionary consumption and under-provision for many, but a field day for some’.
- Is the NHS worth saving? Although the evidence is presented that the NHS does a good job with high levels of satisfaction financial pressures are acknowledged.
- Why rake over the past? This question is actually better answered by Timmins but for those involved in the passage of the legislation it is interesting how it was observed by those closest to it.
- At this stage what can the opposition do? Here we discover the significance of the David Owen Bill to annul the controversial aspects of the Act and the legal advice that the Secretary of State can once more be moved centre stage relatively quickly and easily in a new parliament.
- Can effective opposition be created? Although events in other countries show that determined oppositions can trump even the most resistant governments, it is shown that even when the opposition to Lansley’s Bill was at its highest, voters were more concerned with the economy and jobs than healthcare. The authors of course have plenty of ideas for those interested in continuing to oppose the Act.
Ultimately I fear the authors of ‘NHS–SOS’ are preaching to the converted. The only people that may be won over will be those concerned at the high-level lobbying and influence peddling, seemingly aided and abetted by politicians of all parties. Vignettes exploring the tendrils of McKinseys and the major consultancies working with the large multinational healthcare corporations should concern all who wonder where things are leading.
Although Timmins suggestively places a question mark after his title ‘Never Again?’ the feeling after reading both books is that although whichever party wins the next election will claim the NHS is safe in their hands, the likelihood is that all the main parties will be ‘persuaded’ by large donations from vested interests to be prepared to compromise on aspects of policy. Despite everything, healthcare is still behind the economy and jobs in the minds of the electorate. The economy is not getting any better and politicians remain vulnerable to snake oil salesmen promoting investment, efficiency savings and better quality services.
People who worked in the NHS during the 1980s of tight cash limits, long waiting lists and an implacable Treasury know they had to wait until the early to mid-2000s before there was significant investment and waiting lists declined. Even now the NHS gives false reassurance. There is underconsumption of healthcare resources by international standards and there are plenty of willing collaborators in this. After all it feeds the market for private healthcare from which most NHS consultants do very nicely.
Although other European countries seem to manage to have higher consumption of healthcare resources, better quality of services with more money extracted from the punters’ pockets without adverse consequences for the poorest, there is no willingness among politicians to admit this. Admittedly the evidence is sparse and debateable but the cry of “the NHS is the envy of the world” seems ever more difficult to sustain and the trend appears to be towards forms of the social insurance model.
This I believe was the attraction of the Lansley Act: to put in place arrangements that would evolve in this direction over time without any further legislative initiative. Or that will be the hope of politicians of all parties and the large healthcare corporations offering so-called ‘solutions’. We can confidently predict therefore not another ideological war for the future of the NHS but another example of the perpetual political struggle fought by forces offering a better set of compromises than others. Not ‘Never Again’, but ‘Plus ca change’. The investment in buying both these publications will be money and laser ink well spent. They help to address the question ‘what was that all about?’ and to map what may be coming. The conclusions people draw and the action they take will vary according to the place they see themselves in the new world.