Those of us who fought hard against the Health and Social Care Act of 2012 (and I did, most especially on Twitter) always knew the danger within that Act.
Clause 1 said:
But then this was added:
That section changed the whole focus of the NHS. The Secretary of State might still be responsible to parliament, but operationally they had the obligation to devolve power to others, who would be autonomous.
So, hospitals would be autonomous.
And physical and mental health would be autonomous.
As would primary and secondary care be separately managed.
The ambulance service was unrelated to the rest of the healthcare system.
Social care might as well have been on another planet.
And in a structure where everyone was autonomous, managing to meet their own budget constraints without incentive or concern to consider others, it was inevitable the system would collapse as a result of this deliberate fragmentation.
That collapse has now happened, as those who campaigned a decade ago thought likely.
What is happening in the NHS is not an accident. It was done by design. And Andrew Lansiey, the architect of this failure, sits in the House of Lords, no doubt happy with his handiwork.
But given how so very obviously the NHS was destroyed, isn't the direction of travel - which has to be towards re-integration - now obvious?
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Another elements of the Lansley reforms was a requirement to put all services out to tender. This has had the impact of a) tying up clinical time in helping to construct the service specification and additional management time and costs b) introducing the private sector in more and more services- which of course are completely separate creating further interfaces and barriers c) taking funding out of the NHS and creaming off “profit” ie usually a reduced level of qualified staff / service
Where the private sector has not won the tender they have on occasion sued the NHS – taking more time and money.
I do wish some investigative journalist would actually look at this.
True
I came across this publication this evening . This might answer your wish.
https://keepournhspublic.com/product/peoples-covid-inquiry-executive-summary-document/
Lansley “reform” issues pre date Covid, have been going on for the past 8 years and are not criminal / fraudulent in the same way. Covid PPE issues are a separate issue.
My mother went into a home around this time and, as I had been doing some work for MIND, I booked a session with one of their staff to learn more about funding it. Mum was almost 100 and had nothing to leave my brother and I apart from her flat. She kept saying how she could do something for us as my childhood in a single parent household didn’t have much. I never had the heart to tell her that there was a a cutoff point of about £23,000 and most would go on her care. I did apply for continuous nursing care as she was functionally deaf . with very poor sight and bed bound, but was refused. Promises to raise the limit had been made by Cameron and Osborne and then retracted. I think the limit is still around this figure.
The MIND lady told me about the 2012 Act which seemed to have passed me by. I didn’t remember it being debated. One consequence was that MIND could deliver some mental health work under the Increased Access to Psychological Therapies. I was aware of that afterwards.
I bought a book NHS SOS which has a number of authors including Professor Pollock of Queen Mary University. I learnt that press coverage had been very patchy. Also that a number of medical institutions, including one for GPs had argued against it. They were assured by senior people in the medical establishment that there were figures in the House of Lords who would remove the worst aspects. It didn’t happen. The more cynical of the contributors suggested that some medical institution leaders were concerned about their knighthoods. I can’t comment.
My impression is the toxic press we have in this country, played down reporting as they knew it would be unpopular.
I now read that this government say the Act needs to be replaced.
When we look at the lack of preparation for a pandemic and the corruption in the awarding of contracts ( while ignoring genuine suppliers), the delays in lockdown and premature lifting of restrictions, it is not be wondered at that (according to the world meters site) we have the second higher covid death rate in western Europe behind Italy.
Cameron’s ‘the NHS is safe in our hands’ ranks with Neville Chamberlain’s ‘Peace in our time”.
Professor Allyson Pollock is wonderful. She co-wrote the private members’ bill that Caroline Lucas tried to introduce to repeal that pernicious Health & Social Care Act of 2012 (and which was defeated by appalling gerrymandering by the Tories which meant it ran out of time). Allyson Pollock warned of the dangers of the Act at the time in this excellent TED talk and I have been sharing it ever since – to little effect. https://www.youtube.com/watch?v=Cz5dl9fhj7o
I have worked with Allyson
Good on the NHS
Failed on Covid, I am afraid
A very important thing that has to be said.
I’m very interested in the population’s response to this. By any measure, the Tories have been putting a noose around their necks by undermining the NHS with both under-funding it and BREXIT. But we know its more complicated than that.
I know plenty of people who have paid to go private. But would they vote the Tories out at the next election?
How does an acceptance of this policy actually work in the population?
There will be those who will pay and be proud to pay because they can – this will set them apart from others and some people like this – it signifies their ‘success’ and individualism to be un-reliant on the NHS. This is the Randian contingent perhaps?
There will be those who have paid, and because they have paid they think everyone else should do so too – a sort of belligerent reverse leveling effect at work here. I’d call this group the ‘Sufferance Co-operative’ – they’ve had to put up with it and so will you and they will enjoy seeing you suffering like them. We must all suffer together but not think about things getting better together – oh no – that’s socialism!!
And there will be those who have swallowed the lie that we as a country can’t afford it anymore – there are just too many people and we should never have tried to have an NHS in the first place – the Fatalists.
And of course there’s your Faragists – it’s because we’ve had too much immigration and this feeds their inherent racism to the point that discussion about budgets and policy just don’t mean a thing because it’s them immigrants innit?
Does anyone think that the Tories don’t know this above or along similar lines?
On top of that we can also look at how private medicine in this country sells itself to sick and frightened people – it’s all about speed isn’t it and contrasting itself with the ailing public service service that has been strategically provided for them by our government so that people are funneled toward them. How kind.
The worst of it is that people see this privatisation process as natural – some sort of natural order – that the NHS was/is unnatural because it was always doomed to failure.
Looking at your quote from the Social Care Act, the way it reads to me is similar to how the Tories made LA Housing Revenue Accounts the sole responsibility of councils (autonomous). Except that government can limit the rent rises we set to meet actual costs of that operational responsibility and the Treasury can also tell us to mess around with our reinvestment interest rate!
So, the 2012 Act promotes ‘autonomy’ whilst not mentioning a commitment to financing (or resourcing) the existing NHS service and therefore opens the door for other providers. Autonomy of course in the NHS will come in as Trusts decide what to cut and let go with reduced budgets.
It ‘s not that Lansley was clever (the Act is plainly anti-NHS at least to me) , it’s the brazenness/audacity of writing it and getting it through parliament. This is its most worrying feature – that it has more cross party support than we think, and that the MSM have also declared it a no go zone in terms of explaining it to the British people and what it really means.
As I said, a good post to start the year on.
Thanks
Your last par is key. In the weasel words of the odious Streeting: New New Labour will not return to 20th century models of provision. Which decoded means no return to nationalised state provision regionally directed by Strategic Health Authorities. Privatisation, outsourcing and fragmentation will not be reversed by a change of government. New New Labour, no different to the Tories except we deliver neoliberalism with a sad face and faux regret instead of with a smile and relish
The Act got through with the support of the Liberal Democrats- one reason why I will never ever vote for them. I went to see my Lib Dem MP – it was eye opening. he had taken the advice of the Lib Dem health lead – that the Act was fine, and that was as much “research” into it as he was going to do. It seems to me that on most occasions the vast majority of MPs are just nodding donkeys, voting how the party tells them too. The bigger question therefore is who is it that is puling the strings and directing party policy?
You would expect there to be a measurable difference between outcomes in Wales and Scotland and those in England. Is there an analysis that shows that, other than the recent one primarily based on outsourcing of IT.
The assumption is naive when the funding is the same, in essence
Speaking from Scotland – management thinking here is much the same too. There are lingering traces of a “shared” health service, but Scotland’s NHS is too small and too close to be insulated from England’s NHS. The Lansley miasma spread across the border long ago. Scotland is interdependant with England for e.g. staff, training, professional organisations, technology, private and not-for-profit service providers of all sorts. The Scottish health service, and social services, have been driven into the same pit as their English counterparts.
I’m not in a position to comment on NHS Wales, its structures or performances, but NHS Scotland differs from NHS in England in that it swiftly discarded individual Trusts (which had been imposed on NHS Scotland by the Tories as part of their so-called “internal market reforms” of the mid 1990s) after devolution in 1999. In their place NHSS reverted to a structure of regional boards responsible for Acute services and Primary Care services on their region.
The result has been better outcomes in a wide range of organisational practices and key performance indicators. For instance better rates of pay; free tuition and bursaries for student nurses & midwives; more qualified doctors, nurses, midwives, ambulance drivers etc per head of population; more cohesion in IT hardware, systems and data collection etc.
Thanks Ken
As a postscript to my post at 4:14pm here’s a link to a paper discussing some of the ways that NHSS has developed separately from and more effectively than the NHS in England:
https://www.nuffieldtrust.org.uk/files/2017-07/learning-from-scotland-s-nhs-final.pdf
Peter Blackledge is right in his statement that the NHS in Scotland is “too close to be insulated from England’s NHS” and the principal impact of this is in its financing. Scotland doesn’t have its own currency and the Scottish Gov has very limited borrowing powers, so Scotland’s public services are almost totally dependent on the Barnett Formula providing the necessary funding. However, the Tories’ obsession with shrinking the state automatically reduces the amount spent on public services in England and consequently reduces the financial support for the devolved nations. The NHS in Scotland can’t reach its potential as long as current UK Gov policies remain in force and, with Labour at present offering nothing better, Independence is the only way Scotland as a whole and NHSS in particular can protect and improve the lot of its people.
Mr Mathieson,
Two well argued comments, if I may say. Finance is not enough of course; but the NHS has been starved of resources for the last twelve years, deliberately in an ideological Conservative obsession with shrinking the state, no matter what. Whenever the Conservatives say they are now supplying money (toolittle, too late); it cannot majic out of thin air the urgently required nurses and medical staff that are no longer there, and cannot either replace or recruit in suffiient numbers; and we have even cut off the supply of european resources post-Brexit. The problem is over a decade of neglect and cynical depletion in the name of ideology.
Dis-integration has been leitmotif (leading motive) of this Tory administration which has played out like some Wagnerian opera. NHS dis-integration. Brexit dis-integration. The Union dis-integration. Public service dis-integration. parliamentary democracy dis-integration.
All of which leads, inevitably, to the disintegration of trust. It’s also leading to the situation where the number of beneficiaries of the current system is reducing. Without sufficient beneficiaries regimes crumble.
BUT ahead of that we have crisis. We are experiencing crisis at various levels. State, institutional, individual. Each can get through to the other side stronger. However doing that requires a period of reflection on what we value and what is broken so that we may wisely decide upon the pieces we take forward and those we discard and in doing so will build a new identity.
The alternative is chaos making drama and distraction which prevents the underlying issues being faced – which is stressful and depression lurks below the surface. So we fall apart and struggle to carry on?
Turning back to the party in power. Was the crazy short lived, unstable, Truss premiership the climax of an extended ‘mad scene’ in our overblown opera, the moment where the Conservatives became a danger to themselves and the country? And a question for 2023. What may really be inspiring their behaviour?
For sheer Tory, bigoted, small minded, silliness – re the state, the NHS and what constitutes the right expectations of government please see this interview with Steve Baker:
https://www.churchtimes.co.uk/articles/2022/29-april/features/power-is-a-disgusting-awful-thing-steve-baker-mp-interviewed
He believes that Victorian Friendly Societies were the appropriate response to poverty and illness of the poor, “But kind hearted people, who wanted to expand the benefits of Friendly Societies to everyone, destroyed them with the 1911 National Insurance Act and later with the establishment of the NHS” He argues that these undermined people’s independence and chance to fulfil themselves as caring human beings and that we can’t afford this kind of state intervention in any case – as it can no longer be funded out of taxation now that people are living longer and having fewer children.
Though there were no Friendly Societies – a lack of state healthcare didn’t work out so well in the time of The Black Death – and no state health provision would have been a disaster at the height of the recent pandemic with many millions dying. Perhaps his idea only works if there are fewer of the people who live longer and they can all afford private health.
This is Baker arguing for feudalism
He is, in my opinion, a very nasty piece of work
The argument is a standard right-wing trope
Two articles from the the Guardian.
06/02/2017.”One in six A&E departments at risk of closure or downgrade”
As many as 33 casualty departments across the UK could be lost by 2021 in an attempt to save £22bn from the NHS’s budget.
02/01/2023. “Senior UK health official warns of “unsafe and undignified” care due to A&E delays. December set to be the worst month on record for A&E waiting times as up to five hundred people estimated to die each week due to delays.
Thanks, Richard and to the contributors.
Well said Richard! It has been obvious since the Tories came into power in 2010 that the destruction of the NHS as we know it was their aim. But the media and opposition seem too scared to say so. The Tories have devastated NHS dentistry by a blatant policy of attrition without a murmur of criticism so why wouldn’t they feel confident to use the same policy on the NHS itself? As I’ve said here before, I have no doubt whatsoever that Truss’s foolhardy tax spending plan was an attempt to justify euthanising austerity cuts on the NHS in order to be the Tory Golden Girl who pushed NHS privatisation over the line. I’ve just sent off a message hammering the 38 Degrees campaign to protect the NHS, which I have supported, for their description of the Tories’ ‘chronic neglect’ of the NHS.
If they are going to use such weasel words to describe the Tories’ vile, cynical policy there’s really no hope of their campaign achieving anything. More strength to your elbow Richard.
The scraping of the ‘retained EU law’ and the implication of Health and Social Care Act of 2012 will finally get the Tories into the place they want to be this New Year . The outpouring of hopelessness on the Radio 5 live this morning will make no difference , the real point is .. vast amounts of people have not been paying Attention . When you take into account the Labour Party have not flagged up their intention to change these Laws and Acts , then where/ who do we turn to for hope of a more Caring and Equitable Society ?
I wish I could answer that
We need to follow the money to Tufton Street where American and UK capital is promoting the commodification of public goods. Just watching American TV medical adverts shows where we are heading.
Good article. However in some ways the NHS is author of its own downfall. It should have rebelled years ago. This last minute rebellion in dire circumstances leads it straight into a trap of the Tories and National press making. Patients are dying from lack of care or access and the nurses go on strike? How long before the scapegoating starts on this? The nurses risk becoming a straw man.
I agree: doctors should not have accepted impossible risks years ago. My wife, a retired GP, would agree.