The Socialist Health Association was amongst the first to come out and resolutely oppose the Equity and Excellence Liberation nonsense that eventually became the Health & Social Care Act. At the start of the long fight to oppose the Bill only a minority actively opposed it, led by Labour and the major trade unions; far too many who should have known better gave the Bill a muted welcome.
The SHA was clear in its analysis that the aim of the Bill was to start the move of the NHS onto a regulated market basis following the path set by the Tories in respect of the utilities. Over time it would have ended the NHS as we know it. It was designed to favour greater entry of private providers in all parts: provision, and commissioning and back office support. It made market competition (initially on price, which was dropped) the driving force for change in the NHS. For the first time it brought compulsory competitive tendering for clinical services. The Bill’s apologists openly boasted that it removed political control over the NHS just as it removed accountability and direction.
Most never believed the private sector would take over all, or even most, of NHS services but they could have been allowed to cherry pick the ‘profitable’ bits. They were expected to extend their entry into primary and community care and that has happened.
It was a long fight and there were two opportunities to kill the Bill. If the GPs had clearly stated they wanted no part of it (they did not want to be commissioners) the Bill was doomed – but the GPs did not say that and GP based organisations were amongst the supporters. Then much later on once some of the flaws became blindingly obvious the collective voice of the Royal Colleges could have fatally wounded the Bill – but after much prevarication the great and the good of the professions found they did not have strong enough objections.
So we got the Act and, as the Kings Fund and others point out. we got an expensive and unnecessary reorganisation.
The NHS in 2010 needed direction and a period of stability to try to deal with austerity as best it could. Social care was in a mess. What was needed was reform and investment in social care and a strong policy direction towards integration. We got a bigger integrated mess.
Arguments that the Act reduced management costs and improved quality don’t stand up to any serious analysis. Similarly claims that the private sector is poised to take over all services are still also untrue.
So where now?
Well perhaps the last thing we need is another top down imposed reorganisation. We also have to stop thinking of the NHS as somehow outside the rest of the public services, outside any democratic control with its own unique structures. And we have to genuinely start to accept patients and communities as assets.
So that does not mean no change, it means changes take place locally at different rates looking at the whole system not just the NHS. It means bringing planning of services under democratic control and firmly within the family of public services. It means allowing changes to take place without external interference from competition rules or regulations. It means integration in all its meanings. It means personalisation of services in all its meanings. It needs new solutions not a return to some mythically golden era.
The Ten Year Plan announced by Labour moves in the right direction but until the funding issues are resolved it may be too ambitious even for a ten year horizon.
Having won the battle of ideas and relegated competition and markets into a more sensible place the new big arguments are about making social care far more effective, making whole person care a reality and finding ways to bring stable funding.