On 22 January 1989, The Sunday Times carried a report on its front page detailing Margaret Thatcher's plans to reform the NHS. I happened to be its author, thanks to a friendly mole who dropped the review into my lap 10 days before it was due to be published.
Re-reading my yellowing cutting of that story 21 years later, I was struck by the parallels with Andrew Lansley's announcement last week. "The basis of the reforms," I wrote then, "is to separate the payment for health care from its provision. Long-term aims are to encourage greater private investment and produce a service that provides better value for money and more consumer choice. The core of the proposals is aimed at creating a competitive market within the health service. [The review] proposes releasing hospitals and large group practices of GPs from the grip of NHS bureaucracy to encourage entrepreneurial innovation and to give them a more business-oriented approach."
Sound familiar? It should do. This may help solve one puzzle about Lansley's white paper, "Liberating the NHS", namely, how it was produced in just 54 days, after the Conservative party had declared at the election there would be no more top-down reorganisations of the NHS. Answer – all it took was a few tweaks of the document that launched the NHS reforms two decades ago.
The Conservative governments of the 1990s had eight years to implement their plan before Labour won power in 1997. There was then a hiatus, until in 2000 Labour embraced the idea of market-led reform with the creation of NHS Foundation Trusts and GP "total commissioning pilots", such as that in Cumbria, which are indistinguishable from the GP consortia envisaged by Lansley.
So the market in healthcare, offering private organisations the chance to compete, is not new – we've had it for almost 20 years. Has the NHS been taken over by the private sector in that time? No. Is the NHS still recognisably a national service, publicly funded, comprehensive and free at the point of use? Yes. This gives me confidence about the future, unlike the growing body of doom-mongers. The NHS is a vast organisation that is slow to change. There is little evidence that the reforms of the past two decades have had a major impact on the service. Its fundamental values of universality, comprehensiveness and free access are lodged deep within the national psyche.
It is said that Lansley's ideologically driven vision is more radical than anything that has gone before. But Mrs Thatcher's vision was just as radical. Both sought an answer to the NHS's perennial problem – how to wrest more value out of a service that is running out of funds. "Disruptive" innovation is Lansley's answer, as it was Thatcher's – finding better ways of delivering more care for less money. That may mean a bigger role for the private sector. How big? My betting is not excessively so. It doesn't spell the end of the NHS – yet.
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