This book is the latest in a series of books, which I have written over the last thirty years, which analyses the politics of the National Health Service in the UK, in particular its repeated ‘re-disorganisations’ posing as reform. The focus is on England, as the rest of the UK has often followed a different path since devolution in 1998-99.
The book brings the story right up to date, culminating in the Health and Care Act of 2022. This Act can be seen as an ironic change of direction for a notably right-wing Conservative government. It reverses the ‘market reforms’ initiated by Margaret Thatcher and continued (after an interregnum) by Tony Blair and his Health Secretary Alan Milburn, reaching a dubious apotheosis in the ill-fated reform designed by Andrew Lansley for an unsuspecting and rather negligent Coalition government, culminating in the Act of 2012.
The book demonstrates that polemic and rigorous academic analysis are not necessarily antithetic. The latter part of the book is suitable for the general reader, student, academic and policy-maker alike.
One noteworthy aspect of the book is the discussion of the UK government’s abysmal handling of the Covid pandemic. Even in comparison to the lacklustre performance of other countries, the UK approach was egregiously negligent and reckless, as argued in the three chapters of Part III. The prime culprit was the former Prime Minister, Alexander Boris de Pfeffel Johnson and it is both timely and important to remind ourselves of why this conclusion is justified. Otherwise, there is a danger that subsequent world events (and the fact that the Public Inquiry into Covid is limited in its terms of reference), will let the great escape artist and ‘gambler’ off the hook. Another irony is that the justified outrage over the government’s approach to Covid restrictions as ‘rules for thee but not for me’ will divert attention from the related but more important issue of its mishandling of the pandemic, resulting in tens of thousands of unnecessary deaths, morbidities, and cases of ongoing disability from ‘long Covid.’
Of course, there is more to the story than the actions of one individual, however baleful his influence. The book also argues that both the stripping of the UK’s health protection apparatus to its bare bones in the years since 2010 and the subjugation of the official medical and scientific advisory function to political control (the former unintentionally; the latter intentionally) were both facilitated by inappropriate reforms to the structure of the NHS. This had a detrimental effect upon the wider public health protection apparatus, compounded by the so-called ‘austerity’ beginning in 2010.
The book concludes by warning of the real and present danger facing the NHS’s very future. Opponents of inappropriate reforms are often accused of glorifying the past. The writer is not guilty of this (although I would say that, wouldn’t I?) Indeed, as one of the endorsements of the book on the back cover notes, I actually slaughter a few sacred NHS cows by arguing that reform is needed, but that it should be in terms of substantive access to substantive services, rather than ‘zombie policy’ which would reinforce previous ideology-led errors in organisational reform.