Why any change to the NHS is always opposed

Health Minister Simon Burns on how the same arguments against change by a small and very vocal minority are to the detriment of a more meaningful conversation about the NHS

Opposition to change is part of the NHS’s history. You could perhaps see it as a backhanded compliment to the enduring love and respect the NHS commands.

The fact that some opposition is inevitable doesn’t mean it should be dismissed out of hand.

Any major reform should be properly debated. Health professionals, patients and the public should be contributors to that debate and the ultimate shape of the reforms. In the case of the reforms we’re currently discussing, they have contributed with considerable impact, aided by the independent NHS Future Forum.

But it’s surprising how often the same arguments against change are wheeled out by a small and very vocal minority, often to the detriment of a more meaningful conversation about the NHS we should be having with the public. It seems that regardless of the nature of the reforms proposed, the arguments against are static, both in style and content.

There’s a weary familiarity to the rhetoric.

Privatisation. A US-style insurance system. An end to free healthcare.

‘Is not creeping privatisation the cup of poison that the Government have planned for the NHS? … Will not this pernicious privatisation mean more personal bankruptcies from bad health and the shrinking of available treatment on the NHS?’

Not a comment on the current reforms we’re proposing, but MP Harry Cohen’s verdict of the NHS review, speaking in the House of Commons in 1988.

He’s in good company. Stick ‘creeping privatisation’ and ‘NHS’ into the Hansard search engine, and you’ll find over 25 years’ worth of parliamentary invective. Almost without exception, every major change to the NHS has been caricatured as a relentless march towards the end of free healthcare.

In 1992, the MP for Blyth Valley, Ronnie Campbell, described the creation of NHS trusts (yes, trusts, not even foundation trusts) as ‘…a small step to privatisation’.

‘Patients will have to pay for treatment or to stay in hospital, in the same way as the Government introduced charges for eye tests and dental services,’ he declared.

Or take Professor Allyson Pollock’s verdict on the Health and Social Care Bill.

‘Unless the legislation is amended, Bevan’s legacy and the principles of universality and comprehensive care upon which the NHS was founded will be destroyed, and the Health and Social Care Bill will indeed be the last act of the NHS.’

Except it wasn’t the current Health and Social Care Bill she was referring to, but the 1999 Bill that bore the same name.

Two years later, it was invention of primary care trusts that came under fire: ‘There is a spectre of US-style health maintenance organisations, to which new structures of the NHS must conform,’ she wrote in 2001, in the British Medical Journal.

These are the same primary care trusts that, with her co-authors, in last week’s British Medical Journal, she now insists we must keep at all costs.

So after nearly three decades of doomsaying, what do we have? An NHS that still provides a universal service, free at the point of use, and is as far removed from a US-style insurance system as any other health service on the planet.

It will remain resolutely so, as we’ve made clear in law.

Privatisation. The spectre of a US-style insurance system. Such accusations have become political grenades carelessly and indiscriminately lobbed at anything that looks like change. The NHS’s history is peppered by their deployment, and to be frank, they’ve been so overused over the past few decades, they’ve become rather meaningless.

It’s time to grow up. There’s no contradiction in being passionate about the NHS and everything it stands for, while believing it can and should be better.

But that’s the dividing line that many of the reforms’ most vociferous opponents try to draw: you’re either for the NHS, or you’re against it. If you’re for the reforms, you’re against the NHS and you’re hankering to sell it to the highest bidder.

It begs the question: what do those who oppose the reforms actually stand for? The status quo, which will be impossibly stretched by increasing demand, and will only become more so as our population ages and the cost of new treatments goes up?

Or do they agree that we do need to change? And if they don’t think the current reforms will deliver, then perhaps it’s time they came up with an alternative.

In Health and Social Care Bill, News, Simon Burns | Tagged , , ,

25 Responses to Why any change to the NHS is always opposed

  1. M Pearman says:

    This is disgusting why not leave well alone,people that worked for the NHS to do a service for people are now going to suffer because they will not be able to pay for the private treatment same as the dentist, it will be left again for the rich,disgusting,leave well alone.

  2. Rod Whiteley says:

    I think you’ve rather missed the point. The NHS cultivates a comforting illusion that it’s a benign monolith, completely free and the envy of the world. PCTs don’t broadcast that they award contracts to any willing provider. Foundation trusts don’t remind patients that they’re independently-managed public benefit corporations. The NHS Choices website doesn’t have the logo of the private company that runs it up there beside the NHS logo. On the contrary, the NHS’s own pervasive anti-capitalist propaganda conceals how the NHS really works.

    It isn’t that people are opposed to the reforms. It’s that they fear having their comforting illusion dispelled. Rational argument will never make headway against that irrational fear.

    If the NHS were subject to independent public scrutiny, a more educated public might start to engage in a more rational debate about healthcare, yet the current reforms will leave public engagement in the control of health and social care providers. It’s not time to grow up just yet, apparently.

  3. Mark Earls says:

    The question is not should there be any change but whether these changes are the right or wrong ones – whether or not the proposals are a. rooted in a profound understanding of the issues b. based on credible evidence.

    In addition, it’s worth observing how self-defeating this kind of (increasingly common) rhetoric is: merely seeking to stigmatise any opposition to the wide scale changes proposed as partisan, partial or self-interested is both patronising and unhelpful: whether the proposals are right or wrong, implementing them will require recruiting supporters inside and outside the health service (not pissing people off).

  4. Jackie Murray says:

    Mr Burns should try explaining his theory to the thousands of PCT staff facing the spectre of ‘commissioning support organisations’ (not in the Bill), which, by 2016, will have been forced to leave the NHS and become private, profit making ogansiations or social enterprises. As one of those employee’s, I am currently being sent on a mandatory Capita run ‘customer service’ training day, to help prepare for the new world. I am a commissioner and a clinician yet my experience, and that of many others, apparently counts for nothing. All this whilst simulatneously being offered voluntary redundancy and advertising new posts (a band 8a ‘quality lead’ anyone?).

  5. Jon Green RGN MSc says:

    This article is propaganda for the Health and Social Care Bill

    Therefore it should not be on a government website in advance of the bill’s approval it is is party political!

    This represents gross misuse of the DH website

  6. Helen Bunter says:

    I agree with Jon. this is Tory propaganda an the department of health website is not the right place for it. Put it on the conservative website if you must.

  7. Karen Greenwood says:

    This piece is party political and I object to its inclusion on the DH site.

  8. Andy McAllister says:

    This article is a purely political piece and should be on the Conservative party website rather than the DH. As an NHS manager for 12 years I am increasingly shocked and appalled by the increased politicisation of DH over the last 2 years. DH used to promote evidence-based change – instead they are reduced to political platitudes and the misuse of information (e.g. that the reforms will save 5000 lives a year from cancer deaths, when the data shows that it is earlier diagnosis that saves the lives and has nothing to do with the reforms).

    Nobody denies that the NHS needs reform, primarily to deal with the increasing age of the population and to reduce costs. However, the health and social care bill does nothing to address these issues – in fact it risks a huge increase in costs as GPs struggle to deal with commissioning, as they fail to keep activity within budget, fail to get value for money from contracts, and private organisations (both commissioning and provision) take out a proportion of the budget for profit.

    A lot of people arent against the private sector or competition within the NHS, but recognise this bill as the start of complete marketisation of the NHS without any evidence of its benefits. It would be insructive for all concerned if the DH risk register were to be published so everybody can be appraised of the serious risks to the NHS and patients that this bill represents.

  9. Raul Bottici says:

    Why is this party political diatribe on a departmental website? Were civil servants involved in its production and publication? What was the cost to the taxpyer?

  10. sheila marsh says:

    I agree with Jon Green, this piece is blatently party political and should not be on a publicly funded website. Where are your legal eagles, DH??

  11. M.Cooke says:

    I wouldn’t refer to every Royal College and the 1000s who signed petitions and attended rallies as a ‘small minority’. It is difficult to find anyone to speak in favour of the bill – certainly no one voted for it, so much for democracy. As for ‘wearying rhetoric’ many of the examples mentioned above are indeed ‘creeping privatisation’, the tories wouldn’t have been able to get this far if there had not already been ‘creeping privatisation’ and this is another large step towards outsourcing the entire NHS just as much of social care has already been outsourced leaving us with private care homes taking their slice of public funding then leaving us to pick up the tab when they make a mess of it.
    Change may be needed but this bill does not address any of the issues of increased aging population, it will cost more to deliver & be more beauraucratic. As to alternatives, Burns knows well that they have been put forward and ignored.

  12. MG says:

    I agree this is party political propoganda. The DH website should not carry this tripe. If I want party political trash I will read a newspaper or watch TV. The DH website should be non political. As NHS employees we have to sign away the right to state our own political views in the name of the NHS, DH employees should surely have to do the same.

  13. Alison Barkshire says:

    And the Government and your assertions, Mr Burns, that these “reforms” will improve patient care is something other than rhetoric. It is also strongly party policitcal – what is it doing on DH website? Just another example of how this government has completely trashed democracy. Could you please explain how, if as you say: “The status quo, which will be impossibly stretched by increasing demand, and will only become more so as our population ages and the cost of new treatments goes up?” your reforms address this if it isn’t by excluding some treatments/ care and / or charging for others? A change in management structure does not of itself address these issues.

  14. John Hughes says:

    If Mr Burns is permitted to publish this on the DH site there should be an obligation to publish an article from the oposite point of view as a matter of balance.
    The goverment have sort to divide the public and private by repeating this sort of article. Change is needed and there are some good parts to the bill but the change must be evidence based. We need informed debate not spin and political dogma that damages our society.
    The genocide in Rwanda started as political dogma to divide a population. The outcome may be different but the intention is the same. Simon Burns knows what he is doing.

  15. Patrick Manning says:

    What is this piece doing here? Disgraceful misuse of public funds for party politics. As a taxpayer, I object to its inclusion on this public department’s website. Please take it down, or post an equally-prominent counter-argument.

  16. Christopher McCabe says:

    I may be missing genuine policy information in this post – but it certainly reads like a political polemic against the critiques of the bill – its not even a factual based argument as to why the bill will improve the NHS. In which case, it is not apolitical and does not belong on the DH website.

  17. Gary Lines says:

    I agree with Jon Green, this piece is blatently party political and should not be on a publicly funded website.

    This shows how desperate the Government is and how like the BBC the DH is doing as their bosses tell them. Their boses being this unelected government

  18. Cole says:

    Maybe we should get some lawyers to check out if the government should be using this site for dishonest party poetical propaganda.

    A small and vocal minority seems to describe very nicely the few people in favour of this bill.

  19. Simon Burns@DH says:

    I read the points raised here that the blog is party political, but I am a health minster, based in the Department of Health, so I think it’s only natural that the Department’s website hosts a blog on a minister’s point of view.

    In fact, it’s similar to the speeches that I give at various meetings and engagements. Those are published on the DH website too.

  20. John Skarp says:

    Simon Burns! you should be ashamed of yourself. These reforms were in no manifesto offered to the public, and are the biggest shake up of the NHS in the past 60 years. Cameron expressly promised both no more top down re-organizations of the NHS and no further EU interference in UK affairs. These bill is a blatant breech of these promises and will come back to haunt the Tory and Lib Dems in years to come as costs spiral out of control and health coverage decreases. Characterising the opposing of 500,000 people and just about every professional body involved as a small vocal minority just proves how little you care about the NHS, those who work in it or rely on it.

  21. Anita says:

    I think I object particularly to the statement of the ‘small and very vocal minority’. The antagonism to the bill is much more the majority view of NHS workers, judging by all the polls of GPs, physicians, nurses etc.

    We do need to continually improve our promotion of health and health care, but these reforms will make this more difficult. As a doctor who took voluntary early retirement last summer from a PCT, I know that far too much management time has gone on NHS bill changes rather than NHS health and health care.

  22. Paula says:

    That article is incredibly condescending and thoroughly insulting to all members of the health profession who actually work within the NHS. There is a certain ‘eye-rolling’ quality to the tone like you are speaking to a naughty child. Patronising the 1.7million people that work for the NHS is not a very professional thing to do, and indeed not exactly smart.

    “Small and very vocal minority” – I think you should check your sums. Vocal, yes. Minority, no.

    The NHS that the nation loves and cares about should stop being played about with like a toy for political gain and notoriety.

  23. Ian says:

    Afraid it’s true that we are not going to be able to afford to continue with the status quo. Any government would have to do the same as the current one is doing. This country has changed from being a producer to a consumer and it cannot afford to pay its bills any longer. The only way we were able to afford extensive public services in the period following the second world war was because we had a highly successful economy and the resultant tax take was able to fund it. But not any more.

    As Simon says, it’s time to grow up. Dad can’t afford to buy us new toys any longer and it’s no use throwing a tantrum.

  24. EH says:

    I agree that this is party political propaganda and, in my view, represents a misuse of the department of health website.

    To be clear, the reasons many people (not a minority) oppose this bill are because, in the first instance it makes a mockery of democracy (there is no mandate, it has been implemented prior to approval, the views of health professionals have been wholly ignored), and secondly, it will not do what it claims to, e.g. to address the challenges faced by a 21st Century health service. It is poorly drafted, repeatedly amended and so complex that I’m not sure anyone truly grasps its implications, but it replaces three layers of management with 5 (arguably 7), making the system more beauracratic, not less, and it does not address the key issues facing the NHS going forward. All it does is attempt to pass the buck to GPs so that in future years when tough decisions are needed politicians can distance themselves.

  25. Sue Gerrard says:

    I was taken aback to find political rhetoric on what is supposed to be a site informing the public about a service they are funding.

    As a member, apparently, of a ‘small and very vocal minority’ who has significant concerns about the changes proposed for the NHS I should like to point out that locally, we are already seeing the consequences of the interactions between independent services that are inadequately co-ordinated or monitored.

    If a service organisation is aiming for (or required to achieve) direct profitability or to break-even, there are some service users that it will not want as its ‘customers’. My local medical practice, out-of-hours service and hospital all try to avoid taking responsibility for complex and difficult cases that are likely to prove time-consuming. Privately run companies are free to do this, which is why some of them are ‘successful’. Services intended for everybody can’t pick-and-choose, so they safeguard their bottom line by sidelining patients who are likely to be a liability.

    My objections to the proposals aren’t because I don’t like change, they are because I have a background in organisational theory and have seen enough of the documentation to know that there are some major organisational issues which haven’t been thought through. In fact I’ve been increasingly concerned over the last three decades, that successive governments have shown little understanding of organisational issues.