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The NHS under the coalition government Part one: NHS reform

Historians will not be kind in their assessment of the coalition government’s recordon NHS reform. The first half of the 2010–15 parliament was taken up with debate on the Health and Social Care Bill, the biggest and most far-reaching legislation in the history of the NHS – designed (largely by the Conservative party in opposition) to extend the role of competition within the NHS and devolve decision-making. The Bill attracted widespread comment and criticism, including from The King’s Fund (Dixon and Ham 2010). It was eventually passed into law only after an unprecedented pause in the legislative process, and extensive amendments following the work of the NHS Future Forum. An unnamed senior government source has recently acknowledged that the decision to promote the Bill was ‘a huge strategic error’ (Smyth et al 2014) and, as we show, its effects were both damaging and distracting.

The second half of the parliament was devoted to limiting the damage caused by the Bill and dealing with the effects of growing financial and service pressures in the NHS. The squeeze on public finances may not have affected the NHS as much as most other public services, but in the context of rising demand from an ageing population, it has struggled both to keep within budget and to hit key targets for patient care. The government responded by redirecting funding to ameliorate the impact of these pressures, amounting to £700 million in 2014/15. It also sought to shift debate away from the technocratic and unpopular changes in the Health and Social Care Act (2012) and towards patient care and how it could be improved. This resulted in a welcome focus on the safety and quality of patient care.