Thread by @HPIAndyCowper

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. navigator.health.org.uk/theme/working-…

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. civilserviceworld.com/in-depth/artic…

When the Five-Year Forward View was published in 2014, I was one of one people who spotted what it was actually doing: healthpolicyinsight.com/editorial-thur…

"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: healthpolicyinsight.com/editorial-thur…

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). healthpolicyinsight.com/editorial-frid…

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)

https://twitter.com/DrMurphy11/status/1360006915099607040

#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. healthpolicyinsight.com/editorial-thur…

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.