Restoring a sense of balance to NHS reform

Abstract

While the recent receipt of royal assent for the 2012 Health and Social Care Act in England represents the end of a long process for policy makers, its ramifications will reverberate around the NHS in England for years to come. The Bill’s passage through parliament was a messy business, one that could form a classic ‘how not to do it’ text for tomorrow’s students of politics. But the reality is that health reform always feels momentous and is usually an imperfect and painful process. The NHS market reforms in the 1990s and the managerial reforms of the 1980s were probably more radical than the current ones. The vitriolic opposition to the Obama health reforms in the US1 make the negotiations over the Health Bill look like child’s play. And the introduction of competition over the last two decades in Sweden has been much more countercultural than anything ever seen in UK.2 People care about health, and that is why reform is associated with passionate arguments based on deeply held values, selective use of evidence, and not a little Machiavellianism on both sides. Reform leaves bruised egos and damaged relationships between those involved, and a mixture of bewilderment, cynicism, and sometimes a sense of guilt from those who have, for whatever reason, not taken to the streets or taken up their pens in opposition. So, as tempers calm and those who work in the NHS do what they always do — try, to the best of their ability, to make the system work — now is a good time to stand back and take a dispassionate view of the policy processes underpinning health system reform. This is not as straightforward a question as it might appear. Most obviously, reform aims to address known deficiencies in the established system. The …