History (as interpreted by Irwin) Repeats Itself?

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.