NHS Reform and Health Politics in the UK : Revolution, Counter-Revolution and Covid Crisis

This book provides an original analysis of the trajectory of health policy reform in the United Kingdom from the beginning of the Thatcher reforms in the 1980s right up to the latest changes in England in 2022. Rooted in political science and health policy analysis, it tackles key arguments around the new integration of the NHS since 2015, what the new and emerging NHS structure represents, the UKs poor response to the Covid-19 crisis, and the future threat to a comprehensive public NHS. It includes significant new material on what has happened since 2015, such as the politics of the Covid-19 pandemic, the effects of Brexit, and the conundrum of social care. The book is a scholarly and polemical analysis from an expert who has studied the politics of health services for more than forty years. It will be a key resource for students, academics and policy makers. Calum Paton is Emeritus Professor of Public Policy at Keele University, UK. He chaired the University Hospital of North Staffordshire NHS Trust between 2000 and 2006, and was Editor-in-Chief of the International Journal of Health Planning and Management between 1998 and 2019. He has authored ten books and numerous articles on health policy and politics Preface References Contents About the Author Abbreviations 1 Introduction References Part I The Market Revolution 2 Conservative Ascendancy: The ‘Internal Market’ The Internal Market—Technical Fix or Political Fist? Planning and Markets Enthoven—A ‘Man from Mars’ The Thatcher Factor The NHS Market in the 1990s: Politics Takes Over References 3 New Labour’s ‘Initiative-Itis’: A Missed Target Searching for a Narrative: The Third Way Governance and the ‘Purchaser/Provider Split’ Budget-Holding by GPs Primary Care Groups NICE and CHI The NHS Plan, 2000 Targets Permanent Revolution: Blairite Restlessness Shifting the Balance, 2001 New Labour’s New Market, 2002 Foundation Trusts The Mid Staffs Foundation Trust The Private Finance Initiative (PFI) Piecemeal Policies: Rationality, Arationality and Irrationality Garbage In, Garbage Out? Stands Scotland Where It Did? Wales In Hindsight: New Labour’s Confused Governance of the English NHS References 4 The Coalition Government’s Blunder: The Lansley Reform The Road to the 2010 White Paper: GP Commissioning and Market Provision Shock and (Not Much) Awe Cameron’s Hand Forced: The NHS Future Forum The Lords Step Up to the Plate Making Sense of the Senseless References 5 The Cost of the Market Direct Costs of the Market Market or Multiple Reorganisation as Source of Direct Cost? Wider, Indirect Costs of the Market References Part II A Corrective Counter-Revolution 6 Counter-Intuitive Tories: The Health and Care Bill A Sea Change ‘Simon Says’ The Health and Care Bill Coming Full Circle References 7 Left Behind: Opposition to the New Approach Suspicion—My Enemy’s Policy Must Be Wrong The US Connection Unpicked ‘Corporate Rationalisation’ Need Not Be Private More Detailed Worries A Different Objection to the HCB: The ‘Commissioning’ Lobby The Balance Sheet—Unpicking the Threads of Confusion Conclusion: Future Improvements References Part III Covid Crisis 8 Catastrophic Policy: A Reckless Regime The Covid Disaster: An Initial Summary Structure and Agency—A Double Failure Professional Advice ‘Following the Science’? ‘Kissing Up’ to Government? Herd Immunity ‘We Did Everything We Could’? Vaccination Delta References 9 Living with Covid? References 10 The Reckoning A Compromised Scientific Establishment? The British Press and Other Media Conservative MPs The Joint Committees Report National Audit Office Rationalisation of Failure and Inaction False Comparison Corporate Manslaughter? References Part IV How Much Pressure Can the NHS Take? 11 Toxic Cocktail: A Hangover from Austerity, the Pandemic, Brexit and Barely Sorted Social Care The Legacy of ‘Austerity’ and the Pandemic Brexit, Trade Agreements and Uncertainty Social Care Reform of Social Care Devil in the Detail The Pandemic on Top of Austerity References 12 Real Reform? Some NHS Sacred Cows The Department of Health: A Suitable Case for Treatment References Afterword: The NHS at 75 Years Old—On the Critical List Index