Two - Coalition health policy: a game of two halves or the final whistle for the NHS?

Summary

Introduction

The King's Fund audit of coalition health policy (Ham et al, 2015: 1) claims that the first half of the 2010–15 parliament was taken up with debate on the Health and Social Care Bill (HSCB), while the second half was devoted to limiting the damage caused by the Bill and subsequent Act and dealing with the effects of growing financial and service pressures in the NHS (see also, Seldon and Snowdon, 2015: 540). While previous Social Policy Reviews have focused on the first half (Ruane, 2010; 2012; Mays, 2011; Heins, 2013), there has been little coverage of the second half. However, was it a case of a game of two halves or did the coalition reforms bring about the final whistle, signalling the end of the NHS?

This chapter examines both halves of the coalition government's health policy (see, for example, Burchardt, 2015 and Glasby, 2016, on social care). After a brief ‘extra time’ exploring the early period of the Conservative government elected in May 2015, it provides a ‘match report’ of temporal, intrinsic and comparative evaluation templates. ‘The final whistle?’ explores the debate on the ‘end of the NHS’ in terms of the issues of privatisation and financial crisis/sustainability.

First half: the Health and Social Care Act

Many commentators regard the reorganisation of the White Paper, Equity and Excellence: Liberating the NHS (Department of Health, 2010a) and the subsequent Health and Social Care Act (HSCA) of 2012 as the biggest change in the history of the NHS (for example, Ruane, 2010; 2012; Mays, 2011; Heins, 2013). For example, according to Hunter (2013b), the changes ushered in by the HSCA are different in both scope and intent from anything to which the NHS has previously been subjected. According to Seldon and Snowdon (2015: 181), this ‘NHS debacle’ was ‘the biggest cock-up of Cameron's premiership’. Widely regarded as a ‘car crash’ of both politics and policy making, it was, in the words of Sir David Nicholson, then NHS chief executive, ‘the only change management system you can actually see from space’ (quoted in Timmins, 2012).

Timmins (2012) relates the story that before the 2010 election, David Cameron promised ‘no top-down reorganisations’ of the NHS (see also, Seldon and Snowdon, 2015).