six - The prospects for NHS reorganisation post-2010

Summary

Introduction

But of all the changes that were enacted by the 2012 Health and Social Care Act, the decision to abolish a large proportion of the organisations that comprise the NHS in order to replace them with a whole new set of organisations that only those with the most arcane interest in NHS management structures will ever be able to tell apart is probably the least useful. (Taylor, 2013, pp 85-6)

Chapter One opened with a quote from Roger Taylor suggesting that NHS reorganisations have achieved little other than changes in ‘letterheads and job titles’. What the evidence presented in the first five chapters suggests is that the common currency of healthcare reorganisation contains rather fewer examples of successful change than we might hope. There are, however, also some successes from which we can learn.

This book has considered research examining the NHS reorganisations of the 1980s and 1990s, and in more depth, those attempted by Labour, especially during the 2000s, elaborating the central control and local dynamic programme theories that underpinned their reorganisations of the NHS in England during that decade, to produce more detailed accounts of what appears to work, and also how, and under what circumstances.

Although central control mechanisms have been shown to be problematic in hospital settings, the QOF in the area of general practice has shown there is potential for their adaptation. Local dynamic mechanisms, such as patient choice and competition, and PPI, demonstrate isolated examples of working well, but are areas where it is far more difficult to produce a detailed programme theory that shows how reorganisation can work well because of the significant problems they have encountered in both policy design and implementation.

This chapter explores what these elaborated programme theories can tell us about NHS reform after 2010. Following the general election that year, the coalition government put in place a radical programme of reorganisation for the NHS in England, courting significant controversy in the process, and resulting in changes that have been referred to as the most significant in the history of the NHS (Hunter, 2011). This chapter considers the nature of the coalition government's reorganisation, and the prospects for it working based on research evidence from previous chapters.