The coalition’s NHS reforms managed to combine a massive government-imposed re(dis)organisation with the end of the duty of government to ensure healthcare is provided where and when it is needed. NHS SOS explains how it happened, why it matters and what we can do about it.
The principles underlying the reforms are that the traditional model of medicine as a vocation, healthcare as a public good and the sick patient as a vulnerable citizen who has a right to care and for whom the state has a duty of care are no longer fit for purpose in an era of market values where medicine is a business, healthcare a transaction and the sick patient a customer. The righteous anger that comes across in the book comes from the knowledge that the NHS reforms will punish the poor, the elderly and the chronically sick and will harm the rest of us when we are most vulnerable.
The seventh chapter of the book, co‑authored by Professor Allyson Pollock and researcher David Price, is the clearest statement of why it is so important to defend a publicly funded and provided, planned and accountable national health service, and is a good place to start for anyone still wondering what all the fuss is about. They explain that the first clause of the Health and Social Care Act 2012 has repealed the duty of the secretary of state to provide or secure a comprehensive health service and assert the pivotal significance of this change: ‘This repeal was the fulcrum of the free-market agenda, since this long-standing duty compelled the minister to allocate resources according to need instead of leaving allocation to market forces and unaccountable organisations.’
And yet this book is not so much a lament for the NHS but for democracy. Democracy, the contributors of NHS SOS argue in painstaking detail, is corrupt. From political parties to trade unions, academic royal colleges and the media, all are charged and found guilty. There is too much lobbying, too many vested interests and, among those uncontaminated by these sins, too little understanding of what is at stake.
It is all too easy to feel dismayed by what is happening to our NHS, but the strength of the book is the authors’ indefatigable and contagious passion for the genuine public engagement upon which a national health service that puts patients before profits depends. The final section of the book is a guide to ‘What you can do to save the NHS’. In essence it’s a guide to how to become a politically engaged citizen. It would appear that we are only going to be able to save the NHS if we can save democracy.