NHS Titanic: battered, but not yet sunk

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With the Health and Social Care Act a reality, critics and supporters are predicting extreme results. In fact, it is more likely just to chug along, getting increasingly worse for wear

Unlike the HMS Titanic, NHS Titanic cannot be sunk, at least not easily and not in a hurry. That is the realistic view of what will happen now that the Health and Social Care Bill has become an Act.

There are plenty on both the Left and Right of politics who would dispute that. The more outrageous acolytes of neo-liberal policy hope that is precisely what the Act will do (and more Tories believe it secretly). It will privatise a large proportion of the provision of health services, if not their funding, in fairly short order and that, they believe, is a Good Thing. Their opponents on the Left also believe that is what will happen, although of course they think it is a Bad Thing. They are both wrong.

Don’t get me wrong, I do believe the Act will have serious and damaging consequences, just not exactly the ones either proponents or opponents believe.

Firstly, will it lead to large scale privatisation? I don’t believe so for several reasons. The first is practical; to build up a private sector supply-side capable of taking on a majority of the NHS funds which will flow through CCGs would probably take a decade or more. A myth has grown up about the previous era of privatisations, under Thatcher, that it all happened in a short time-frame. It didn’t, it took two parliaments at least. These sort of very large scale changes cannot be done overnight except in very exceptional circumstances (like a war).

Secondly, I still think that even if this was logistically possible, political opposition to such a move would halt it in its tracks long before it got to that stage. That opposition will be stimulated by the almost inevitable scandals, law-suits and crises that will occur as some unscrupulous GPs and private health companies try to grab a slice of the pie.

That is not to say that relatively small, but significant, chunks of NHS provision will not be privatised. In some cases they will probably do a good job, and make modest profits. In others they won’t do a good job and/or they will seek to make outrageous profits. Perhaps more important will be the disorganising effects and growth in ‘transaction costs’ that will ensue. Both of these will affect privatised and non-privatised parts alike, as even the majority of still-public provision will have to adapt to ridiculous contractual and administrative arrangements associated with greater ‘commercialism’.

The reorganisation involved to CCGs will itself be, and already is, costly and disruptive. And many of the much need real changes will simply not happen in the ensuing chaos. Those in charge, right across the system, will have their eyes fixed on the ‘reforms’ when they should be concentrating on making efficiency and effectiveness changes.

With so-called ‘protected’ funding the health system is actually being squeezed between increasing demand and health-specific inflation on the one side and frozen funding on the other. This is set to last for at least another five years, if not longer. Even without change, or with better change than this, NHS services are set to deteriorate. Sensible Tories and Lib-Dems know that there is a real danger the public will blame their reforms, even when they are not really the cause of lengthening waiting times, poorer services, more scandals and more painful rationing.

NHS Titanic will probably look a bit like a huge liner that ran into an iceberg and didn’t sink – severely battered and a lot the worse for wear, but not yet sunk. The majority of NHS provision – my guess would be 70-80% at least – will still be a public, but very battered, service.

There are undoubtedly some in the neo-liberal think tank undergrowth who recognise this but that hope this will lead on to public disillusionment with the NHS and demands for, or at any rate tolerance of, further privatisation. Only time will tell if they are right. I severely doubt it. This Titanic NHS will not be sunk that easily.

This blog first appeared on Whitehall Watch

About Colin Talbot

Colin Talbot is Professor of Government in the School of Social Sciences (Politics), University of Manchester, and a former adviser to the Treasury select committee. He writes and comments widely on public management reform. Colin has worked with numerous national and international public sector organisations, as an adviser, consultant and researcher. He blogs at Whitehall Watch.

2 comments on NHS Titanic: battered, but not yet sunk

  1. Des McConaghy says:

    I recall interviewing David Owen for a local government journal back in 1981 after he became the Leader of the Social Democrat Party. At that time Owen was a great enthusiast for local income tax and he wanted “democratically elected health authorities with access to LIT somewhere down the line”. However his main point back then must surely stand out today as the most dangerous feature of the present legislation. “Doctors are taught that you cannot play around with the body dramatically. As a radical I am bound to push hard. But skill and judgment about what the system can take is the essence of politics”.

    I also remember reminding Oliver Letwin of this good advice when we all first got wind of the Health Bill…and I daresay his colleagues have since had plenty of time to ponder David Owen’s other reservations in the Lords. But civil service leaders have often drawn attention to safe limits of public expenditure changes if all sorts of completely unforseen but unfortunate consequences are to be avoided throughout the system. Various official opinions surfaced from time to time as to what the safe margin for innovation may be in any one year but without reaching a clear conclusion. In the meantime, like the Titanic, the NHS sails steadily on!

  2. Eddy Ventolera says:

    As the NHS is squeezed between reduced funding and increased costs, every single penny that finds its way into dividends, bonuses or lobbying budgets is more pain, more deay, and more heartbreak for somebody somewhere.

    An efficient public service is what we should be setting up, not a market driven hybrid with confusingly mixed objectives of better public health education, ever more successful intervention and business growth.

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