Another NHS Re-organisation | More plucky memes!

Over the last week there has been on line anger over a vote in the House of Commons to stop the NHS being part of a future UK/US trade deal. The vote itself was pretty much meaningless political posturing. The response on social media was full of plucky memes fighting NHS privatisation, complete with made up quotes from Nye Bevan.

Once again the real story is happening elsewhere.

Dominic Cummings plans another reorganisation of the NHS in order to centralise power in his own hands. I won’t even try and pretend that it is Boris or Matt Hancock pulling the strings on this. Cummings, an individual with no management or administrative experience or aptitude, is being allowed to re-shape not just the Civil Service but all of our civil institutions in his own, centralised, unaccountable image.

Regardless of what the memes say this re-organisation has nothing to do with NHS privatisation.

The plans include dismantling the whole of the NHS internal market, scrapping the purchaser/provider split, ending earned autonomy for Foundation Trusts. Structurally the NHS will be back where it was under Jim Callaghan. All of the pro-market reforms brought in by Lansley are going with them.

Scrapping the Lansley act is a very good thing, scrapping the internal market even better, but creating a new era of Dominic Cummings neurotic central control is a disaster for the service.

While all of that is going on the amount of outsourcing of patient care continues to fall. Most recently the entire private hospital sector was brought under NHS control, and the last remaining large scale private sector contract (Notts ISTC) was brought in house. The NHS isn’t being privatised no matter what the memes tell you.

That isn’t to say that NHS back office functions won’t continue to be provided by the private sector or that contracts for those functions won’t be handed to Dominic’s mates. They will. But these NHS back office functions have always been provided by the private sector. Nothing new there.

These planned reforms, along with the UK leaving the single market, are the Conservative Party trashing the last legacy of Thatcherism. There are still Thatcher nostalgics in the Tory ranks, but Thatcherism is dead and buried. Those few bits that survived Blair and Brown have bitten the dust. Local Conservative Associations might have photos of St Margaret on the wall, but her ideas and her intellectual vigour have been quietly flushed down the toilet.

Despite this lots of people on the left are still convinced that the Conservatives are neo-liberals or Thatcherites.

This is completely wrong. The current Conservative Party isn’t any kind of liberal. It is authoritarian, English nationalist and socially conservative. It’s instincts are reactionary – to use Brexit as a chance to turn Britain backwards into some dimly thought out vision of the past, all Spitfires, bunting and casual racism.

Even Dominic Cumming’s jumble sale mix of techno-futurism and big data propaganda is rooted in nostalgia for the post war era, particularly big state post war America.

Structurally these reforms are more radical than the last Labour manifesto which which rather oddly wanted to end all private sector involvement in the NHS, but had no plans to get rid of the internal market. Cummings is going further in trashing the NHS internal market than Labour promised in their last manifesto

The authoritarian big state ideas of Corbyn and Andrew Murray are remarkably similar to the authoritarian centralisation of Dominic Cummings, and are just as stupid.

The people who like to call the current Government neo-liberal also like to use the same words to describe the last Labour Government.

The difference between Blair on one side and Corbyn/Johnson on the other are 2 different visions of the NHS. The Blair era vision centred on devolving decisions locally, and allowing variations in how services are delivered where it created good outcomes for patients. Patients were encouraged to make choices about where they had their treatments, and in some cases what kind of treatment was best for them. Clinicians were encouraged to take the lead in shaping services, although this was often more of an aspiration than a reality.

The Corbyn/Johnson vision is a centralised bureaucracy, with homogenous services mandated and controlled by a small group of politicians and technocrats. No local decision making, no clinical leadership, no autonomy. Politician centred services not patient centred care.

The sad reality is that we have been here before. Politicians have tried to run the NHS as a centralised bureaucracy before, neurotic and controlling. It was a disaster every time it was tried.

It was a disaster during Covid, where the combination of unaccountable centralised decision making and populist gimmickry led to Formula 1 motor racing teams being asked to make ventilators that didn’t work, and millions spent on empty Nightingale hospitals while thousands died in nursing homes.

The left can fight these changes and develop it’s own vision for local decision making, or it can nod them through while occupying their time with plucky memes on social media.

So far the response is not promising.

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