Search

This Perspective argues that the NHS in the UK is facing a critical 'tipping point' which means that its very survival is at stake. The article considers the political responses to this crisis-(briefly) from the Conservative government; (briefly) from the 'anti-NHS' Right in politics; (briefly) from the 'centre' in politics in the form of the Tony Blair Institute for Global Change; and (in depth) from the left-of-centre, the Labour Party. Labour is likely to form the next government, which is why its approach (in terms of both political strategy and the substance of health policy) is considered in depth. It is argued that Labour's approach, derived from an understandable desire by leader Sir Keir Starmer to disown its 'unelectable' recent past, is currently inadequate for the task of putting the NHS on a secure footing for the future., (© 2023 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.)

Background: The UK government's reckless and incompetent response to Covid-19 has produced an outcome which is amongst the worst in the world, and arguably the worst in terms of deaths per 100,000 population of major countries (especially when one measures mortality from Covid in terms of cause of death on the death certificate, rather than the UK government's own measure-death of a tested individual within 28 days of testing). This article updates my initial analysis in this journal over a year ago, and traces the negligent and shambolic policy-making, and supine official scientific advice, which has led to such a dismal outcome., Methods: It does so by examining the policies and approach of the UK government from the begining of the pandemic (in UK terms, January 2020) up to June 2021. All relevant declarations, speeches, decisions, public interviews and policies were noted on a daily basis, examined and critically assessed-along with daily data and information over the whole period on Covid's threat to, and spread across, the UK., Conclusions: On three successive occasions, Boris Johnson and his compliant Ministers acted too late and too weakly to prevent avoidable death and illness. At the time of writing the vaccination programme in the UK has been destabilised by the government-yet again-having failed to secure its borders, this time against the Delta variant (Indian mutation) of the virus. Overall, in terms of border control, quarantine, testing, tracing, isolation and timely and enforced lockdown, the government put short-term, superficial considerations above coherent strategy. It dressed up its incompetence as a superficial libertarianism and defence of the economy, but thereby managed to achieve the worst of all worlds in terms of three egregious failures-appalling health outcomes; (ironically) worse economic damage than countries which took draconian action; and (also ironically) continually recurring restrictions as a result of earlier failure to take strong action to suppress Covid and keep it at bay. Public reaction in England (unlike in Scotland and Wales) to the Johnson government's shenanigans has not been commensurate with that government's level of failure, which sadly reflects a debasement of the political culture in England., (© 2021 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.)

The new White Paper, Integration and Innovation, prefiguring a Health and Social Care Bill for England, means that the NHS structure in England will have come full circle in the last 32 years, since the Thatcher government began in 1989 to implement the reforms announced that year in the White Paper, Working for Patients (incidentally without waiting for parliamentary approval, which came in 1990). This will be denied by some, who will depict the 'new' integration as only being possible as a result of learning during the various phases of reform over the last 30 years. This is a fallacious teleology. It is argued here that, while the 'old' NHS of the 1980s (of course) required improvement, the persistent 'reforms' of the last 30 years or so have been based on political fads which have been both hugely expensive and, in the end, transitory and self-defeating., (© 2021 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.)

This article gives key reasons for the UK's tardy and confused attempts to react to the COVID-19 pandemic. It explains very poor outcomes in the UK (in terms of the spread of the virus and high mortality, already striking at the time of writing), in terms of an initial lack of political will to prioritise public health, itself a product of a strong Prime Minister who made the "wrong call". It also highlights a failure to "follow the science", except in so far as the "science" had already accepted some dubious political judgements and the lack of capacity to test as the starting-point., (© 2020 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.)

This paper considers health policy-making in the USA with England as comparator. It contrasts policy inertia in US healthcare despite crisis with hyper-activity in perpetual 'reform' in England despite absence of crisis in the NHS. It does so from the standpoint of political science and political economy. I suggest that 'path-dependency', the view that past policy constrains future policy, lacks explanatory power and that wider and deeper explanations must be sought. The USA's apparent path dependency is in fact a story of political economy and power, buttressed by institutions. England's apparent lack of path-dependency in promulgating NHS reform is in fact a story of executive hyper-activism which is oblivious to how implementation will obviate its prescriptions. This failure of 'reform' in the NHS is not a symptom of concealed path-dependency but a sign of pragmatism by those charged with implementation. In the USA, the durability of its various systems of healthcare is by contrast a sign of pragmatism not being adequate to achieve health sector reform. In the USA, a weak state is unable to manage healthcare reform which would actually benefit US capitalism as a whole. In the UK, a strong state has created and developed the NHS to the benefit of capital through the economical provision of healthcare to the workforce. Such an 'investment state' is a testimony to the continuing validity of the neo-Marxist argument that social investment and social expenses are an important and functional component of the capitalist state., (Copyright © 2013 John Wiley & Sons, Ltd.)