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 pioneer, writer, campaigner and commentator. Formerly a clinical optometrist specialising in diabetes and visual impairment, she is the founder and Director of 2020health, an independent, social enterprise Think Tank whose aim is to Make Health Personal and Social. 2020health has through research, events and campaigning influenced opinion and action in fields as diverse as bioethics, alcohol, emerging technologies, fraud, education, consumer technology and vaccination. In 2014, 2020health were founding partners of the Health Tech and You Awards with Axa PPP and the Design Museum. Since 2016, 2020health has increasingly focused on digital health and public health in the community. Julia is a Fellow of the RSA and now also a part-time PhD student at the UCL Interaction Centre, studying the use of digital technology for stress management in the workplace. Julia has shared 2020health's research widely in the media (BBC News, ITV, Channel 5 News, BBC 1′s The Big Questions & Victoria Derbyshire, BBC Radio 4 Today, PM and Woman's Hour, LBC) and has taken part in debates and contributed to BBC’s Newsnight, Panorama, You and Yours and ITV’s The Week.
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