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 is a social pioneer, writer and campaigner. She studied visual science at City University and became a member of the College of Optometrists in 1991, later specialising in visual impairment and diabetes. During her career in optometry, she lectured at City University, was a visiting clinician at the Royal Free Hospital and worked with Primary Care Trusts. She ran a domiciliary practice across south London and was a Director of the UK Institute of Optometry. Julia formed 20/20Health in 2006. Becoming an expert in digital health solutions, she led on the NHS–USA Veterans’ Health Digital Health Exchange Programme and was co-founder of the Health Tech and You Awards with Axa PPP and the Design Museum. Her research interests are now in harnessing digital to improve personal health, and she is a PhD candidate in Human Computer Interaction (HCI) at UCL. She is also dedicated to creating a sustainable Whole School Wellbeing Community model for schools that builds relationships, discovers assets and develops life skills. She is a member of the Royal Society of Medicine’s Digital Health Council. 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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