The NHS is facing one of the biggest shake-ups in its history. In a time of austerity and facing a £20bn deficit, is now the right time —and are these the right remedies?by Sam Knight / November 17, 2010 / Leave a comment
Published in December 2010 issue of Prospect Magazine
“The man with the plan”: Andrew Lansley, secretary of state for health. Will his plans turn a health organisation into a health system?
Something is going on in the NHS, and most of us do not know what it is. Until now, standing at the threshold of a four-year winter of diminished public services, we have at least been consoled by the apparent stability in our health system. In October’s spending review, the £111bn behemoth was, with education and foreign aid, one of the few corners of the budget to win a slight increase. We have also been emotionally assured by the Tories and Lib Dems that the NHS is safe in their hands. During the short life of his son, Ivan, David Cameron became better acquainted than most with the service. In the run-up to the election he promised not to stop Labour’s spending but to rationalise it and to scrap the Stalinist targets with their unintended consequences. The near-sacred status of the 62-year-old organisation was written into the coalition agreement he presented with Nick Clegg on 20th May. “The government,” they said, “believes that the NHS is an important expression of our national values.”
But the tranquility has not lasted. It turns out that health has been on the reform agenda all along. In the six months since Cameron and Clegg promised in that same coalition agreement to “stop the top-down reorganisations of the NHS,” it has been subjected to the now-familiar blend of devolution, manager-filleting and all-round radicalness that the government seems to be bringing to bear on everything. The NHS will be restructured after all, with most of its budget handed to GPs. Local authorities are taking on responsibility for public health for the first time since the 1970s. The National Institute for Health and Clinical Excellence (Nice), set up to determine which drugs were worth their cost, is being stripped of its authority. And in the midst of this, we have learned what health policy people have known for some time: that the NHS is not financially secure and will experience an estimated £20bn shortfall in the next five years. Health, it seems, has no ringfence, and rather than put the NHS to one side for now, the government has thrown it on the same baize table as everything else: the armed forces, electoral reform, large parts of the welfare system, double dip.