{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,9,3]],"date-time":"2024-09-03T14:16:34Z","timestamp":1725372994261},"reference-count":49,"publisher":"Duke University Press","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,8,1]]},"abstract":"<jats:p>This article analyzes the latest battle in the twenty-year war to change England's National Health Service (NHS), starting with the internal market reforms introduced by the Thatcher government and now carried one step farther by David Cameron's coalition government. The government's program of change is characterized by (1) its wide scope and the organizational upheavals involved and (2) the fact that it is being introduced at a time when the NHS faces unprecedented fiscal pressures. The legislation faced strong political, public, and professional hostility both from those who saw it as a crime against the founding principles of the NHS and from those who saw it as a disruptive blunder that created more problems than it solved. This article asks three questions. Why did the coalition government embark on a policy course guaranteed to lose it votes? How will the much-amended legislation work out in practice: what are the risks and uncertainties? What will be the program's impact: will it, like previous waves of change, disappoint both the prophets of doom and the visionaries of transformation? The conclusion drawn is that the essential, defining characteristics of the NHS are not under threat. It continues to be a publicly funded service, freely available to all. It is not being privatized. But it is moving toward the kind of pluralistic system that would have been established by Britain's last, wartime coalition government, had not Aneurin Bevan nationalized the hospital service in 1948.<\/jats:p>","DOI":"10.1215\/03616878-2210503","type":"journal-article","created":{"date-parts":[[2013,5,4]],"date-time":"2013-05-04T03:36:31Z","timestamp":1367638591000},"page":"849-869","source":"Crossref","is-referenced-by-count":18,"title":["The Twenty-Year War Over England's National Health Service: A Report from the Battlefield"],"prefix":"10.1215","volume":"38","author":[{"given":"Rudolf","family":"Klein","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"73","reference":[{"issue":"2","key":"2022033011160765700_R1","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1258\/jhsrp.2011.011046","article-title":"\u201cInvestigating the Governance of Autonomous Public Hospitals in England: Multi-Site Case Study of NHS Foundation Trusts.\u201d","volume":"17","author":"Allen","year":"2012","journal-title":"Journal of Health Services Research and Policy"},{"issue":"1 (suppl. 1)","key":"2022033011160765700_R2","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1258\/jhsrp.2011.011015","article-title":"\u201cProvider Diversity in the English NHS: A Study of Recent Developments in Four Local Health Economies.\u201d","volume":"17","author":"Allen","year":"2012","journal-title":"Journal of Health Services Research and Policy"},{"issue":"5","key":"2022033011160765700_R3","first-page":"310","article-title":"\u201cDoes Poor Health Justify NHS Reform?\u201d","volume":"342","author":"Appleby","year":"2011","journal-title":"British Medical Journal"},{"key":"2022033011160765700_R4","volume-title":"Public Payment and Private Provision","author":"Arora","year":"2013"},{"issue":"12","key":"2022033011160765700_R5","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1056\/NEJMp1009188","article-title":"\u201cLiberating the NHS: Another Attempt to Implement Market Forces in English Health Care.\u201d","volume":"363","author":"Black","year":"2010","journal-title":"New England Journal of Medicine"},{"issue":"9821","key":"2022033011160765700_R6","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1016\/S0140-6736(11)61782-0","article-title":"\u201cDeclining Health-Care Productivity in England: The Making of a Myth.\u201d","volume":"379","author":"Black","year":"2012","journal-title":"Lancet"},{"key":"2022033011160765700_R7","volume-title":"Refusing Treatment: The NHS and Market-Based Reform","author":"Brereton","year":"2010"},{"key":"2022033011160765700_R8","volume-title":"Equity and Excellence: Liberating the NHS BMA Response","author":"British Medical Association (BMA)","year":"2010"},{"key":"2022033011160765700_R9","article-title":"\u201cBMA Letter Opposing NHS Reforms.\u201d","author":"Buckman","year":"2012","journal-title":"Guardian"},{"issue":"554","key":"2022033011160765700_R10","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1111\/j.1468-0297.2011.02449.x","article-title":"\u201cDoes Hospital Competition Save Lives? Evidence from the English NHS Patient Choice Reforms.\u201d","volume":"121","author":"Cooper","year":"2011","journal-title":"Economic Journal"},{"key":"2022033011160765700_R11","unstructured":"Cooperation and Competition Panel\n          . 2011. \u201cReview of the Operation of \u2018Any Willing Provider\u2019 for the Provision of Routine Elective Care.\u201dwww.ccpanel.org.uk."},{"key":"2022033011160765700_R12","volume-title":"Governance of Foundation Trusts: Dilemmas of Diversity","author":"Day","year":"2004"},{"key":"2022033011160765700_R13","volume-title":"\u201cAutumn 2011 Staff Survey.\u201d","author":"Department of Health","year":"2011"},{"key":"2022033011160765700_R14","volume-title":"Designing the NHS Commissioning Board","author":"Department of Health","year":"2011"},{"key":"2022033011160765700_R15","first-page":"18","article-title":"\u201cWho Will Shape the Market?\u201d","author":"Dixon","year":"2012","journal-title":"Health Service Journal"},{"key":"2022033011160765700_R16","volume-title":"\u201cThe King's Fund Response to the 2010 Health White Paper.\u201d","author":"Dixon","year":"2010"},{"key":"2022033011160765700_R17","volume-title":"Understanding New Labour's Market Reforms of the English NHS","author":"Dixon","year":"2011"},{"key":"2022033011160765700_R18","article-title":"\u201cPrivate Acute Providers Warned of Slowing Growth in NHS Work.\u201d","author":"Dowler","year":"2012","journal-title":"Health Service Journal"},{"key":"2022033011160765700_R19","article-title":"\u201cChairman: NHS Future Forum.\u201d","volume-title":"Summary Report on Proposed Changes to the NHS","author":"Field","year":"2011"},{"key":"2022033011160765700_R20","volume-title":"\u201cDeath by Market Power: Reform, Competition, and Patient Outcomes in the National Health Service.\u201d","author":"Gaynor"},{"key":"2022033011160765700_R21","volume-title":"Territorial Politics and Health Policy: UK Health Policy in Comparative Perspective","author":"Greer","year":"2004"},{"key":"2022033011160765700_R22","volume-title":"The Department of Health and the Civil Service: From Whitehall to Department of Delivery to Where?","author":"Greer","year":"2007"},{"key":"2022033011160765700_R23","article-title":"\u201cEditorial: From Builders' Charter to Lawyers' Delight.\u201d","year":"2012","journal-title":"Guardian"},{"key":"2022033011160765700_R24","volume-title":"Where Next for the NHS Reforms? The Case for Integrated Care","author":"Ham","year":"2011"},{"key":"2022033011160765700_R25","volume-title":"The Politics of Coalition: How the Conservative-Lib Dem Government Works","author":"Hazell","year":"2012"},{"key":"2022033011160765700_R26","article-title":"Second Report of Session 2010\/11. HC 512","volume-title":"Public Expenditure","author":"House of Commons Health Committee","year":"2010"},{"key":"2022033011160765700_R27","article-title":"Fifth Report Session 2010\/11. HC 796","volume-title":"Commissioning: Further Issues","author":"House of Commons Health Committee","year":"2011"},{"key":"2022033011160765700_R28","article-title":"Thirteenth Report Session. 2010\/2012. HC 1499","volume-title":"Public Expenditure","author":"House of Commons Health Committee","year":"2012"},{"key":"2022033011160765700_R29","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9780511921766","volume-title":"Governing for the Long Term: Democracy and the Politics of Investment","author":"Jacobs","year":"2011"},{"issue":"3","key":"2022033011160765700_R30","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1111\/j.1467-9515.2010.00714.x","article-title":"\u201cThe Eternal Triangle: Sixty Years of the Centre-Periphery Relationship in the National Health Service.\u201d","volume":"44","author":"Klein","year":"2010","journal-title":"Social Policy and Administration"},{"key":"2022033011160765700_R31","volume-title":"The New Politics of the NHS: From Creation to Reinvention","author":"Klein","year":"2010","edition":"6th ed."},{"key":"2022033011160765700_R32","volume-title":"Thinking about Rationing","author":"Klein","year":"2012"},{"key":"2022033011160765700_R33","volume-title":"Laing's Healthcare Market Review, 2011\u201312","author":"Laing","year":"2012"},{"key":"2022033011160765700_R34","unstructured":"Lansley\n              Andrew\n            \n          . 2012. \u201cDear Colleague Letter: To CCG Clinical and Managerial Leads.\u201dApril3. London: DoH. www.dh.gov.uk\/prod_consum_dh\/groups\/dh_digitalassets\/@dh\/@en\/documents\/digitalasset\/dh_133423.pdf."},{"key":"2022033011160765700_R35","volume-title":"Learning from the NHS Internal Market","author":"Le Grand","year":"1998"},{"key":"2022033011160765700_R36","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1136\/bmj.d4205","article-title":"\u201cIs There Evidence That Competition in Healthcare Is a Good Thing? No.\u201d","volume":"343","author":"Mays","year":"2011","journal-title":"British Medical Journal"},{"key":"2022033011160765700_R37","article-title":"\u201cThis NHS Debacle Sets Us Back a Generation.\u201d","author":"Milburn","year":"2011","journal-title":"Telegraph"},{"key":"2022033011160765700_R38","volume-title":"Open Public Services White Paper","author":"Minister for Government Policy","year":"2011"},{"key":"2022033011160765700_R39","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1136\/bmj.d1695","article-title":"\u201cHow the Secretary of State for Health Proposes to Abolish the NHS in England.\u201d","volume":"342","author":"Pollock","year":"2011","journal-title":"British Medical Journal"},{"key":"2022033011160765700_R40","volume-title":"\u201cSixty Years of Privatizing the NHS.\u201d","author":"Powell"},{"key":"2022033011160765700_R41","volume-title":"Implementation: How Great Expectations in Washington Are Dashed in Oakland","author":"Pressman","year":"1973","edition":"2nd ed."},{"key":"2022033011160765700_R42","article-title":"\u201cThe Firm That Hijacked the NHS: An Investigation Reveals Extraordinary Extent of International Consultant's Role in Lansley's Health Reforms.\u201d","author":"Rose","year":"2012","journal-title":"Mail"},{"key":"2022033011160765700_R43","volume-title":"Working for Patients","author":"Secretary of State for Health","year":"1989"},{"key":"2022033011160765700_R44","volume-title":"The New NHS","author":"Secretary of State for Health","year":"1997"},{"key":"2022033011160765700_R45","volume-title":"Delivering the NHS Plan","author":"Secretary of State for Health","year":"2002"},{"key":"2022033011160765700_R46","volume-title":"Equity and Excellence: Liberating the NHS","author":"Secretary of State for Health","year":"2010"},{"key":"2022033011160765700_R47","volume-title":"A High-Performing NHS? A Review of Progress, 1997\u20132010","author":"Thorlby","year":"2010"},{"key":"2022033011160765700_R48","volume-title":"Never Again? The Story of the Health and Social Care Act 2012","author":"Timmins","year":"2012"},{"key":"2022033011160765700_R49","first-page":"160","article-title":"\u201cReorganisation of the NHS in England: There Is Little Evidence to Support the Case for Yet More Structural Change.\u201d","volume":"341","author":"Walshe","year":"2010","journal-title":"British Medical Journal"}],"container-title":["Journal of Health Politics, Policy and Law"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/read.dukeupress.edu\/jhppl\/article-pdf\/38\/4\/849\/434352\/JHPPL384_11Klein_Fpp.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/read.dukeupress.edu\/jhppl\/article-pdf\/38\/4\/849\/434352\/JHPPL384_11Klein_Fpp.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,30]],"date-time":"2022-03-30T13:35:33Z","timestamp":1648647333000},"score":1,"resource":{"primary":{"URL":"https:\/\/read.dukeupress.edu\/jhppl\/article\/38\/4\/849\/13591\/The-Twenty-Year-War-Over-England-s-National-Health"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,8,1]]},"references-count":49,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2013,8,1]]}},"URL":"https:\/\/doi.org\/10.1215\/03616878-2210503","relation":{},"ISSN":["0361-6878","1527-1927"],"issn-type":[{"value":"0361-6878","type":"print"},{"value":"1527-1927","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,8,1]]}}}