NHS fragmentation – have we heard it before?

Well the quick answer is yes. Back in 1989 the BMA argued in the BMJ that the then proposed health reforms that Ken Clarke was trying to implement would “lay the groundwork for the future dismantlement of the NHS”. It’s a fascinating article that also predicts:

  • Individual episode pricing i.e. having a tariff, won’t happen
  • That self-governing (to become NHS Trusts then FTs) would cream off all the good doctors
  • That patients would no longer trust fund-holding GPs

And in the BMA’s comments on the White Paper, NHS London, their FAQs sheet the word ‘fragmentation’ is du jour. This is sounding quite familiar! And for all the criticism of Andrew Lansley pushing through un-piloted changes (though if GP Consortia were still called practice-based commissioners it might feel more evolutionary), Ken Clarke refused BMA calls for pilots in 1989 because he thought their doctors would sabotage them!

As we’ve written here before we do have concerns about the Health Bill, but ‘fragmentation’ is a scary word that is disingenuous, not least while we have a tax-payer funded universal healthcare system. Maybe the BMA should listen to Michel de Montaigne:

“My life has been filled with terrible misfortune; most of which never happened.”


About Julia Manning

Julia Manning is a social entrepreneur, writer, campaigner and commentator. She is based in London and is the founder and Chief Executive of 2020health, an independent, social enterprise Think Tank whose aim is to Make Health Personal. Through networking, technology, research, relationships and campaigning 2020health has influenced opinion and action in fields as diverse as bioethics, alcohol, emerging technologies, fraud, education, consumer technology and vaccination. Julia studied visual science at City University and became a member of the College of Optometrists in 1991. Her career has included being a visiting lecturer at City University, a visiting clinician at the Royal Free Hospital, working with south London Primary Care Trusts and as a Director of the UK Institute of Optometry. She specialised in diabetes (University of Warwick Certificate in Diabetic Care) and founded Julia Manning Eyecare in 2004, a home and prison visiting practice for people with mental and physical disabilities using the latest digital technology, which she sold to Healthcall (now part of Specsavers) in 2009. Experiences of working in the NHS, contributing to policy development, raising two children in the inner-city and standing in the General Election in Bristol in 2005 led to Julia forming 2020health at the end of 2006. Julia is a regular guest on TV and radio shows such as BBC News, ITV’s Daybreak/ GMB, Channel 5 News, BBC 1′s The Big Questions, BBC Radio, LBC and has taken part in debates and contributed to BBC’s Newsnight, Panorama, You and Yours and ITV’s The Week. She is mum to a rugby-mad son, a daughter passionate about Shakespeare, and wife of a comprehensive school assistant head-teacher. She loves gardening, ballet, Zimbabwe, her Westies Skye and Angus, is an honorary research associate at UCL and a Fellow of the RSA.
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