An analysis of government efforts to shift blame regarding the English NHS

What is it about?

The article analyses democracy within the English NHS. I contend, within the article, that the English NHS has had a democratic deficit since its inception. Although accountability was to be through the Minister of Health to Parliament, the notion of Ministerial control over the NHS was deemed to be a myth. It was argued that power within the NHS resided with the periphery (rather than the centre). In the neo-liberal era, governments have implemented management and market reforms which have centralised control of the service. In addition, governments have sought to reduce their culpability for healthcare through the strategy of institutional depoliticisation (creating an ostensibly independent body to deal with a particular issue). I contend that this strategy is evident in Labour's creation of NICE and Monitor, which were both somewhat successful in removing health technology regulation and the performance of Foundation Trusts (FTs) from political contestation, respectively. I argue that the Conservative-Liberal Democrat coalition (2010-2015) created NHS England (an executive non-departmental public body) to depoliticise healthcare more generally. I conclude that NHS England has the potential to politicise and depoliticise issues. Nonetheless, I contend that government efforts to shift blame to NHS England are unlikely to succeed as the government retains important powers over the NHS (such as determining its funding, which is currently a contentious issue) and the public do not appear to have shifted from blaming the government for healthcare problems to blaming NHS England.

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Why is it important?

The article reveals a tension between government efforts to use law to legitimise changes to social relations, such as the diminution in ministerial responsibility, and traditional views concerning what is legitimate. In respect of healthcare within England, I contend that there is traditional view of social norms and obligations (what E.P. Thompson conceptualised as a moral economy) which views the government as responsible which is likely to frustrate government efforts to shift blame concerning healthcare.