The policymakers who kept changing the prescription
Friday 07 April 1995
When Kenneth Clarke took over from Moore, he helped Lawson to scupper the plans for alternative financing of the NHS, but bought Thatcher's desire for competition between self-managed hospitals in an internal market - and injected the idea of GP fundholders buying care.
Under John Major and William Waldegrave, the language and pace of the reforms were toned down, and Waldegrave put Health of the Nation targets on the agenda. Patient's Charter objectives and centrally funded initiatives to cut waiting lists and improve services took a higher profile. But as Major's administration took a softer line, top NHS management took a tougher one. Peter Griffiths, the deputy chief executive of the NHS, and Eric Caines, its personnel manager, were fiercely pro-market.
Under Virginia Bottomley, the pendulum has swung back and forth. Early encouragement of more vigorous competition - partly at the instigation of Brian Mawhinney, her health minister - has been followed by much more talk of partnership and co-operation. Duncan Nichol, the former NHS chief executive, has been replaced by the more pragmatic Alan Langlands.
Even under Nichol, however, attempts were made to reinstate planning - not just in London - following fears over just how destructive the market could be to the fabric of the NHS. Without that, London hospital closures would have been even more dramatic. The new community care arrived and Mrs Bottomley has pushed mental health up the agenda.
But as some trusts are struggling and fundholding takes on myriad different forms, no one knows whether, three to five years down the road, health authorities or GPs will be buying most care - or which should be. Ministers find themselves denying the ultimate logic of the NHS reforms - that the service could end up publicly funded but privately provided. At the same time, however, they are encouraging the private sector to bid to finance and run NHS services and even entire hospitals. Meanwhile, NHS hospitals are earning record sums from treating private patients.
- 1 Is Gideon Levy the most hated man in Israel or just the most heroic?
- 2 Students offered grants if they tweet pro-Israeli propaganda
- 4 Satellite full of sexually experimental geckos adrift in space, Russia loses control of mission
MH17 crash: Investigators discover more human remains and 'huge section of plane'
Susan Sarandon on David Bowie romance: 'He's worth idolising'
Students offered grants if they tweet pro-Israeli propaganda
A day in the life of Vladimir Putin: The dictator in his labyrinth
Exclusive: Cameron’s Big Society in tatters as charity watchdog launches investigation into claims of Government funding misuse
The 'scroungers’ fight back: The welfare claimants battling to alter stereotypes
Arizona execution lasts two hours as killer Joseph Wood left 'snorting and gasping' for air
Malaysia Airlines MH17 crash: Ukrainian military jet was flying close to passenger plane before it was shot down, says Russian officer
Malaysia Airlines MH17 crash: Massive rise in sale of British arms to Russia
Malaysia Airlines MH17 crash: victims’ bodies bundled in black bags and loaded onto trains
John Barrowman praised for Commonwealth Games opening ceremony gay kiss
Highly Competitive Salary: Austen Lloyd: MANCHESTER - Senior Employment Solici...
£600 - £650 per day: Orgtel: Conduct Risk Liaison Manager - Banking - London -...
Highly Attractive Package: Austen Lloyd: CITY - COMMERCIAL LITIGATION - GLOBAL...
£65000 - £75000 per annum + Benefits: Progressive Recruitment: The client is a...