Does The Future Have an NHS?

The thesis of this book is simple. It states: ‘When the NHS was founded in 1948 it represented a historic, qualitative leap forward over any previous system, superseding the crisis ridden ‘mixed economy’ of health care …. which [was] unable to meet demand. Today, it is being replaced by a new ‘mixed economy’ of health care, a change that the public has never called for or supported, and a system that will cost more but be less efficient and deliver less care. Driven not by evidence but by ideology, the Tories have reinvented the flat tyre.’(p 19–20)

As a GP and thus a connoisseur of the follies of mankind in general I tend to be drawn more to cock-up theories than conspiracy theories. As I have learned more about the Health and Social Care Act and its surrounding regulations (the Act for short) over the past couple of years I have nonetheless been drawn to the conclusion that the likely effects of these ‘reforms’ will be to degrade the social solidarity promoted by the NHS, and that they are ideologically driven. Why else would the politicians fight so hard to block reasonable amendments suggested to mitigate obvious risks? The Act’s omission of the normal preliminary clause that obliges the Secretary of State for Health to ensure the provision of a comprehensive health service is a bit of a giveaway. This obligation was there in every previous Health Service Act. There can only be one possible interpretation to the government’s dogged determination first to leave it out and then to water it down to the point of futility.

This book seeks to answer some vital questions. Will the Act in some sense privatise the profitable parts of the NHS leaving behind a chaotic rump service for the disadvantaged? If so, was this the intention? Why have the media not properly reported such threats? And why (with the very honourable exception of Clare Gerada and a few others) haven’t our own medical leaders opposed these dangers more effectively?

This book gives a detailed narrative account of how these issues have unfolded. The book is onesided in the same sense that when I seek to protect my family from harm I am onesided. It is right that this stance should be examined, but the real question is whether the book is right. If it is then we are witnessing a shift away from the post-war liberal consensus that will downgrade the support our society gives to the vulnerable and sick. It threatens a major worsening of health inequalities. And it appears to be completely without democratic mandate. The Act did not appear in any party manifesto before the election and it cannot claim popular support by the UK population or by the healthcare professions.

• Download figure
• Open in new tab
• Download powerpoint

This book has a Marmite factor. I confess I am not a socialist, at least not with a capital S. This book too often assumes that the reader will be cheering it on from a socialist ticket. This irritated me; socialism is not the only vision for a healthy and caring society. If you are a socialist you will love every inch of this book. But if not then please get over your initial irritation and read it anyway. It is as broad and detailed an exploration of the current NHS ‘reforms’ as you will find. And many of us will share the authors’ passionate concern for what happens next.

Despite my occasional irritation at its tone I found the narrative of this book to be overwhelmingly credible and its arguments valid. If you have any interest in the future of the NHS or the future of UK medicine then buy it and read it. Its thesis — the degradation of social solidarity by conspiracy not accident — deserves scrutiny.

The book’s strap line is ‘how the NHS was betrayed — and how we can save it.’ It claims that the battle is not yet lost. It ends with a plan of action. Whatever your political views, if you care about the NHS then consider whether its core thesis rings true, and if so, what you should do about it.

• © British Journal of General Practice 2014