There is A Big Old Lot Of Bollocks being talked about the Health Bill going back to the Commons tomorrow.
Preventing the talking of such bollocks is a bit of a Sissyphean task, but here goes with a shot at it.
The creation and use of an NHS internal market dates back to Kenneth Clark's 'Working For Patients' reforms.…
The market basically went in and out of policy fashion in the following two decades. Simon Stevensism Mark One leaned on it heavily, with the New Public Management belief that services that were highly measurable and highly contestable could be amenable to market mechanisms.
Here's an explanation of Stevensism Mark One and Mark Two.…
When the Five-Year Forward View was published in 2014, I was one of one people who spotted what it was actually doing:…
"An unsubtle subversive such as myself would summarise the FYFV’s message to political and system leaders as taking a copy of the 2012 Act and scrawling a huge cartoon cock and balls all over it.
"Put less graphically, the message behind the FYFV is ‘we're going to be doing this. And we’re going to deliberately, blatantly ignore key parts of the 2012 legislation, and you're not going to stop us, because we know that you know that it's already overspent chaos in the NHS,
"and it’s going to get worse as the money goes ‘ping!’ That OK with you? Splendid'."
You can read my take on Simon Stevens' legacy here, if you want:…
There is some concerning stuff in the Health Bill. I pointed this out when I was exclusively sent the Bill's text (by someone who'd agreed with my analysis of the Lansley reforms, who wanted it published on HPI, as a source of good critical analysis).…
The real problem area, as opposed to the fantasy privatisation bullshit, is the big increase in the Secretary Of State's powers to intervene in the running of the NHS.
What was, at that time, the "more Matt Hancock" tendency (to coin a phrase) #aha
I'm well aware that people who are really determined to believe the NHS is being privatised have the awesome power of unfalsifiability on their side.
Regional health authorities were preparing the NHS for privatisation. Then GP fundholding was. Then primary care groups and trusts, and strategic health authorities. All were preparing the way for US-style insurers to come in and take over the NHS and sell it off.
The only slight problem with these hypotheses is that they have proven to be complete and utter steaming bollocks.
What the NHS is, in any meaningful terms, is a tax-funded and near-universal healthcare provision obligation. If anybody thinks the private sector is gagging to take that over, they are living on a different planet of economic and political logic.
NHS privatisation is happening? Really? The it's the slowest, shittest privatisation in the entire world.
The Lansley reforms were the biggest effort to introduce 'a genuine market', in the words of the political titan #LordChemsford himself, #SimonBurns4SOS
They tried to make a system driven by patient choice, competition and clinical commissioning.

And they failed utterly.
Simon Stevens frankly took the piss out of them with the Five-Year Forward View. And yep, I was one of one people who spotted that.…
The NHS isn't being privatised, and it never has been being privatised. There are absolutely fucking loads of things that are real and wrong in how the NHS is run. Pick from the demand-funding imbalance; the longstanding workforce crisis; the capital drought. They're all real.
Worry about those real things, and you're probably worth listening to.

Worry about fantasy NHS privatisation, and you're not.
Thank you for coming to my TED Talk.

Now I'm going to have a quiet glass of Chablis. Possibly followed by a few increasingly boisterous ones.

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More from @HPIAndyCowper

7 Jan
Well. This is a thing from Alan.
“The case for the defence of the Health Department during 2020 is that we backed a lot of horses,. The majority of them came home. Some of them had hiccups along the way.
“But ultimately the right thing to do was not to worry about the political and reputational risk of not all these things working. In the public sector, all too often, the attitude is, if we don’t know it is going to work for sure, we shouldn’t do it because it might not work —
Read 25 tweets
7 Jan
Isabel is once again, spot-on. What also emerged today (via @DavidProviders) is that the NHS capital/maintenance/estates backlog has risen over the past year from £6.5bn to £9bn.
If you put an approximate cost of £12bn (by the time there is capacity to get round to addressing the estates/maintenance work), and WLI of around £12-15bn (based on this… plus the additional Covid backlog), then there’s some bracing NHS spending to be done
Oh, and then there is the longstanding NHS workforce crisis to fix.… says £1bn a year, but the impact on current staff of the COVID-19 is very much not priced into this.
Read 5 tweets
6 Jan
The vaccination programme is a great unifier.
It unites the worst and most stupid MPs in the Labour Party…
with the worst and most stupid MPs in the Conservative Party
Read 4 tweets
6 Jan
"As Matt Hancock told us this week, thanks to the wonders of science, 1.3 million people in the UK have now been vaccinated. Science is a field of endeavour previously closed to Britain by the EU, as he has pointed out many times.
"This is almost the same number of people who currently have the virus, which means we’ve vaccinated everyone. We’ve done it. And in record time.

But wait, not the same people, you say.
"Possibly, but it’s an unhelpful distinction only really of interest to public health experts, journalists and other known troublemakers.
Read 6 tweets
19 Oct 20
The lack of performance delivery/enforcement clauses for the outsourcers’ and management consultants’ abysmal performance of their roles in the Test And Trace programme has been getting some new attention this week.
@HSJnews readers know that I wrote about these issues a month ago, linking to and quoting those contracts.…
This week, care minister Helen Whately explained in a written Parliamentary Answer that “contractual penalties are often unenforceable under English law so they were not included in test and trace contracts with Serco or Sitel”.
Read 5 tweets
19 Oct 20
The Cummings-Johnson government is led by campaigners (Mr Dominic Cummings) and former journalists (Mr Boris Johnson and Mr Michael Gove): these are people whose career-fundamental belief is that you can “comms” big, real problems away.
.@HSJnews readers know that you cannot “comms” big, real problems away. They have watched past attempts to do that fail, often with disastrous consequences for patient safety and care quality.
The gulf between Mr Cummings’ lengthily-blogged ambition for a “data-and-delivery-driven” government and the ongoing lousy performance of Test And Trace prove that he is neither a serious person, nor one with the slightest clue of how to fix big, real problems.
Read 5 tweets

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