1. David Hunter Professor of Health Policy & Management Durham University
Healthcare in England: Would it be recognisable to the architect of the NHS?
David Hunter
Professor of Health Policy & Management
Durham University

2. Welcome to the

3. The ‘Redisorganisation’ Game is Alive and Well!
Biggest upheaval since creation of NHS
GPs in charge of commissioning and £80bn
More choice and competition
Localism in place of centralisation
Major role for local government

4. A Plea to Stop Reorganising
...[T]he leaders of the NHS and government have sorted and resorted local, regional and national structures into a continual parade of new aggregates and agencies. Each change made sense, but the parade doesn’t make sense. It drains energy and confidence from the workforce....[T]he time has come for stability, on the basis of which, paradoxically, productive change becomes easier and faster for the good, smart, committed people of the NHS.
Don Berwick (2008)

5. The Marketisation of Public Policy
Language of choice
Reliance on individual: transfer of risk
Relationship between State and citizen is thinner – enter ‘Big Society’
Consumerism in preference to collectivism
Blurring of public-private boundary

6. The Changing Shape of the NHS
Free at point of use
Publicly funded, plurality of providers
From plan to market
The new mutualism – social enterprises
Increased penetration by for-profit commercial companies
From national tariffs to free market – price competition

7. Back to the Future? Independent hospitals
Strengthened role for local government
Growing inequalities in name of ‘localism’
Diversity among providers: social and commercial enterprises

8. Concerns
Commodification of health care started under New Labour – weak defence of NHS
Competition and markets may prove fatal to ideals of NHS
NHS becomes a brand – a ‘hollowed out’ shell organisation
Policy by stealth – no mandate

9. Last Word
[The NHS is] a triumphant example of the superiority of collective action and public initiative applied to a segment of society where commercial principles are seen at their worst.
Aneurin Bevan, In Place of Fear (1952)