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The NHS under the coalition government

Part one: NHS reform

The 2010–15 parliament has been a parliament of two halves for the NHS. The first half was dominated by debate on the Health and Social Care Bill (which was largely designed to devolve decision-making, put GPs in control of commissioning, and extend competition and choice). The second half was taken up with limiting the damage caused by the Bill, with less emphasis on competition and greater efforts to strengthen the regulation and quality of care and prioritise patient safety.

Throughout the parliament, the NHS has come under pressure from constrained resources and rising demand for care, with an increasing number of providers falling into deficit and targets for patient care being missed.

This report covers six major themes of the coalition government’s reform programme:

  • commissioning of care

  • provision of care

  • regulation of care

  • competition

  • governance and accountability

  • integration of care.

For each theme, it describes the situation the coalition government inherited when it came to power in 2010, the policies it has pursued, and (where available) evidence of their impact.

Key findings

This report concludes that the:

  • coalition government’s reforms have resulted in greater marketisation of the NHS but that claims of mass privatisation are exaggerated

  • reforms have resulted in top-down reorganisation of the NHS and this has been distracting and damaging

  • new systems of governance and accountability resulting from the reforms are complex and confusing

  • absence of system leadership is increasingly problematic when the NHS needs to undertake major service changes

  • Care Act has created a legal framework for introducing a fairer system of funding of long-term care.

Policy implications

  • The next government should continue the emphasis on patient safety and quality of care but with less emphasis on regulation and more on supporting NHS leaders and staff to improve care.

  • Further top-down reorganisations must be avoided, but evolutionary and bottom-up changes to the organisation of the NHS are needed to reduce the complexity and confusion of the structures introduced by the coalition government and to allow the implementation of the NHS five year forward view.