Today, Prime Minister Tony Blair has urged people working in the NHS to get behind the government’s reforms and where necessary to accept the closure of some Accident and Emergency Departments. While the Prime Minister is right to point out that the NHS is a deeply conservative institution and that there will always be built-in resistance to such change, it is perhaps instructive, if we think for a moment how we have got into this situation.

Back in the late 1940s the government nationalised more than 3,100 hospitals, homes and clinics. For the first ten years of the NHS there was very little if any capital investment in the service. Planning permission for the first new hospital was not even granted until 1956!

To overcome the problem of capital underinvestment Enoch Powell launched the Great Hospital Plan in January 1962. It promised a £500 million programme over a decade to build 90 new hospitals, drastically remodel 134 and provide 356 further improvement schemes – each costing over £100,000.

However, with the ongoing economic crisis of the 1960s, 1970s and early 1980s the plan was overwhelmed by events. Since 1992, most new capital investment in the NHS has been arranged under the private finance initiative (PFI). However, even with the input of welcome private money, by the late 1990s less than a third of the Great Hospital Plan’s schemes were completed and a third were not even stared.

In recent years, under the general rubric of public private partnership (PPP) the government has championed a whole raft of sound market-oriented reforms in the NHS. In 2000 the Secretary of State for Health, Alan Milburn, signed a Concordat with Britain’s independent hospitals. In 2001 the government made it clear that it wanted the private sector to design, build and operate a new generation of Independent Sector Treatment Centres. And in 2002 the government made it clear that it wanted to establish a new generation of independent Foundation Hospitals. As such, it wanted NHS hospitals to be “set free” from Whitehall control and to have a greater say over how they developed and from where they raised their capital (i.e., the City).

Indeed, in doing all of this, the government not only took brave steps trying to privatise NHS provision but it started to promote the patient choice initiative. But, and here is the rub, who actually opposed Foundations Hospitals and why did they insist on the bill being watered down as it went through parliament?

In reality the Labour left and the trade unions opposed it because it represented the privatisation of provision. As ideologies with a conservative mind set they were worried that the NHS would be simply re-cast as funder of services and not the owner of the bricks and mortar (as if ownership of the latter really matters). The Conservatives opposed it because lacking vision, they could not understand a Labour government putting through such a sound proposal – so they defaulted to opposition for opposition’s sake. What did the traditional independent hospitals sector do? Terrified of the competition that unleashed Foundation Hospitals would represent they lobbied hard with the Labour left and together these three groups – Labour left, Tories and Private Hospitals – helped to water the proposals down.

As a result we are left with a government that has spent a fortune on the NHS and is still trying to push the market agenda forward. Indeed, in many ways more power is in the hands of GPs and patients and a world of cross sector choice is slowly opening up. But sadly – without full Foundation status and all that lovely capital from the City – some services are going to be cut and many are going to be ‘rationalised’.

Any decade now and a prominent trade unionist or even a Conservative politician might argue for greater privatisation of NHS provision so that local A&E services can be saved. But don’t hold your breath. This is Britain where a good old conservative vested interest remains – even in the face of total madness – a good old conservative vested interest.

I say in let’s open up the supply side of NHS provision and privatise the lot. The NHS can remain a funder and kite mark. But we really don’t need the government to own or run our hospitals. So long as they do, they will sadly remain a political football and the people working in them will be kicked from pillar to post. Nurses deserve better than this and the hospitals in which they work should be set free from the state.

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