Insights (Essays)

Insights (Essays) March 2012

Why Any Change to the NHS Is Always Opposed?

Health Minister Simon Burns on how the same arguments against change by a small and very vocal minority are to the detriment of a more meaningful conversation about the NHS

Opposition to change is part of the NHS’s history. You could perhaps see it as a backhanded compliment to the enduring love and respect the NHS commands.

The fact that some opposition is inevitable doesn’t mean it should be dismissed out of hand.

Any major reform should be properly debated. Health professionals, patients and the public should be contributors to that debate and the ultimate shape of the reforms. In the case of the reforms we’re currently discussing, they have contributed with considerable impact, aided by the independent NHS Future Forum.

But it’s surprising how often the same arguments against change are wheeled out by a small and very vocal minority, often to the detriment of a more meaningful conversation about the NHS we should be having with the public. It seems that regardless of the nature of the reforms proposed, the arguments against are static, both in style and content.
There’s a weary familiarity to the rhetoric.

Privatisation. A US-style insurance system. An end to free healthcare.

‘Is not creeping privatisation the cup of poison that the Government have planned for the NHS? … Will not this pernicious privatisation mean more personal bankruptcies from bad health and the shrinking of available treatment on the NHS?’

Not a comment on the current reforms we’re proposing, but MP Harry Cohen’s verdict of the NHS review, speaking in the House of Commons in 1988.

He’s in good company. Stick ‘creeping privatisation’ and ‘NHS’ into the Hansard search engine, and you’ll find over 25 years’ worth of parliamentary invective. Almost without exception, every major change to the NHS has been caricatured as a relentless march towards the end of free healthcare.

In 1992, the MP for Blyth Valley, Ronnie Campbell, described the creation of NHS trusts (yes, trusts, not even foundation trusts) as ‘…a small step to privatisation’.

‘Patients will have to pay for treatment or to stay in hospital, in the same way as the Government introduced charges for eye tests and dental services,’ he declared.

Or take Professor Allyson Pollock’s verdict on the Health and Social Care Bill.

‘Unless the legislation is amended, Bevan’s legacy and the principles of universality and comprehensive care upon which the NHS was founded will be destroyed, and the Health and Social Care Bill will indeed be the last act of the NHS.’

Except it wasn’t the current Health and Social Care Bill she was referring to, but the 1999 Bill that bore the same name.

Two years later, it was invention of primary care trusts that came under fire: ‘There is a spectre of US-style health maintenance organisations, to which new structures of the NHS must conform,’ she wrote in 2001, in the British Medical Journal.

These are the same primary care trusts that, with her co-authors, in last week’s British Medical Journal, she now insists we must keep at all costs.

So after nearly three decades of doomsaying, what do we have? An NHS that still provides a universal service, free at the point of use, and is as far removed from a US-style insurance system as any other health service on the planet.

It will remain resolutely so, as we’ve made clear in law.

Privatisation. The spectre of a US-style insurance system. Such accusations have become political grenades carelessly and indiscriminately lobbed at anything that looks like change. The NHS’s history is peppered by their deployment, and to be frank, they’ve been so overused over the past few decades, they’ve become rather meaningless.

It’s time to grow up. There’s no contradiction in being passionate about the NHS and everything it stands for, while believing it can and should be better.

But that’s the dividing line that many of the reforms’ most vociferous opponents try to draw: you’re either for the NHS, or you’re against it. If you’re for the reforms, you’re against the NHS and you’re hankering to sell it to the highest bidder.

It begs the question: what do those who oppose the reforms actually stand for? The status quo, which will be impossibly stretched by increasing demand, and will only become more so as our population ages and the cost of new treatments goes up?

Or do they agree that we do need to change? And if they don’t think the current reforms will deliver, then perhaps it’s time they came up with an alternative.

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