What history tells us about attempts to change NHS

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Nye Bevan talking to a patient at Trafford General Hospital on the day that the NHS was founded in 1948
Image caption,
Nye Bevan's NHS legacy is both cherished and fiercely fought over

Health Secretary Andrew Lansley has warned the NHS must be reformed or it could go bust but all the signs are that ministers are now in full retreat over their proposed shake-up.

The coalition wouldn't be the first government to come to grief trying to reform the health service. Jonathan Harvey, Political Producer for BBC Radio 4's PM, looks at the problems past governments have encountered.

Much may have changed since the NHS was first launched in 1948 and yet fast forward to today and what would its founder Nye Bevan make of the modern health service?

Lord Warner, who served as minister for health under Tony Blair, says his Labour predecessor would be surprised.

"I think Nye, who was a great reformer, would have actually wondered why we couldn't get on our bikes and reform it."

But he believes it is the public's attitude towards the NHS which is the real road block to reform.

"I think the people have got very attached to their local district general hospitals," he believes.

"People have got it into their heads that if we tamper with some of these local services they're somehow going to be disadvantaged and we've not done a very good job at explaining to them that the world does move on."

In Canada they had a very radical approach to combating public resistance to change.

When the Canadian government deemed Calgary General Hospital no longer financially viable they simply blew it up.

Political will

It's doubtful such an approach would be acceptable here. Which begs the question do politicians lack the nerve to reform the NHS?

Former Conservative Health Secretary Stephen Dorrell thinks it's easy for people to portray politicians as "spineless" but that's not really the point.

"Nigel Lawson famously said that the NHS is the closest thing we now have to an established church, and anyone who wants to change it has to take people with them. You can't simply ask them to believe you know what you're doing."

There's also the problem of imposing change on a workforce of more than a million.

Nick Seddon, from the think tank Reform, says staff have a very powerful vested interest in resisting change.

"Our GPs are the highest paid in the world, no wonder they don't want the system to change".

It's a claim hotly disputed by the doctors themselves, who insist the real problem is the politicians who try to change the NHS too much to often.

"Every time the new reforms come along it's taken about three of four years for the next government, or sometimes even the same government, to abolish that reform and start another one." Dr Mark Porter, from the British Medical Association, suggests.


And then there's the rhetoric around the NHS.

Successive prime ministers have used the health service to gain political advantage.

Margaret Thatcher once said the NHS "is safe in our hands". In 1997 Tony Blair claimed that only by electing him would the public be able to "save the NHS" and recently David Cameron said "it is because I love the NHS so much that I want to change it".

Does the overblown rhetoric make the consensus required for reform almost impossible?

One former government minister thinks so.

"It certainly needs people in the different political parties not to turn the NHS into a political football." Lord Warner says.

All of which doesn't mean reform of the NHS is impossible - but it does rather suggest that despite Mr Lansley's immediate political problems - history too would not appear to be on his side.