The story of the Health and Social Care Act 2012

‘Never Again?’ tells the story of how and why the Health and Social Care Act 2012 – by far the most controversial piece of NHS legislation in more than two decades – became law.

It relates the story of a political thriller – from the legislation’s origins 20 years ago, through the development of the 2010 white paper “Liberating the NHS” and the resultant bill; a bill so controversial that it appeared at times as though the Government might lose it.

It does so from the view point of opponents and critics, but also from the point of view of the man with whom this legislation is uniquely identified – the current health secretary.

On the way, it explains just what it was that Andrew Lansley was trying to do and why the bill was so vast and controversial.

It details the events that shaped it – most notably the Coalition’s now partly forgotten “programme for government”. That document – cooked up purely by the politicians in Downing Street over 12 days immediately after the election in May 2010 – radically reshaped the health secretary’s plans.

Sorting out the “disaster” in the “programme for government” turned what would have been merely a large shift of power and accountability within the NHS into a huge structural upheaval: one that allowed the reforms to be written up as the biggest reorganisation in the 63-year history of the NHS; and one that could become this Government’s “poll tax”.

‘Never Again?’, in particular, is a story of coalition government and coalition policy making. The act is uniquely identified with Andrew Lansley, but without the Liberal Democrats it would have been a very different bill. At the same time, without the Liberal Democrats, there would have been much less fertile ground within government for opponents to sow the seeds of their dissent. Without them, it would have undergone fewer amendments. And yet, in another twist to the coalition tale, without Liberal Democrat votes the legislation would not have passed.

‘Never Again?’ recounts:

  • how Andrew Lansley was banned from talking about the detail of his plans ahead of the election
  • what happened at the meeting that called “the pause” on the legislation
  • how Sir David Nicholson came to be appointed chief executive designate of the NHS Commissioning Board
  • how Andy Burnham revived the opposition to the bill
  • and how the Coalition finessed its legislation through the House of Lords.

‘Never Again?’ also seeks to draw some early lessons from what is widely regarded as a “car crash” of both politics and policy making. But at the same time it explains why the health secretary believes that never again – or at least for the foreseeable future – will the NHS need to undergo another big structural change and raises the possibility that Andrew Lansley could yet emerge as something of a hero of public sector reform.

Lessons learned

Nicholas Timmins’ case study draws out 10 specific lessons from the story of the Health and Social Care Act.

In a separate commentary, Learning the lessons from 'Never Again?', we link those lessons to earlier work that the Institute for Government has done on:

1. policy making in opposition
2. making coalition government work
3. transitions to government
4. the role of the centre of government
5. being an effective minister
6. better policy making.

Timeline

This timeline is published alongside Never Again? The story of the Health and Social Care Act 2012 by Nicholas Timmins for the Institute for Government and The King’s Fund.  It is a visual guide through the events that led to the act reaching the statute book. It sets current NHS reforms within a  historical context - from the creation of the internal market in 1989, to the establishment of the first Foundation Trust in 2004, to the passing of the most recent controversial legislation.

 

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