A response to Rudolf Klein: a battle may have been won but perhaps not the war

The British National Health Service (NHS) is undergoing possibly the most far-reaching set of changes in its sixty-five-year history. While some commentators (like Rudolf Klein) insist that little of substance is likely to change, others consider that the politics of reform may prove quite different on this occasion. The coalition government is committed to restructuring the welfare state and public services and to rolling back the state. The NHS as a popular monopoly public service runs counter to its neoliberal ideology. While (for now) remaining committed to a publicly funded system of health care that is largely free at point of use, the government wishes to encourage much greater diversity in the provision of care, including a much larger role for the for-profit private sector. Despite significant opposition to its proposals, few concessions have been forthcoming, and the legislation that passed onto the statute book in March 2012 remained essentially unchanged. Notwithstanding the lack of convincing evidence, the government is wedded to encouraging greater competition and choice. Thosewho believe the changes will amount to far less than its architects hope for are being too complacent and overlooking the strength of the government's ideological convictions. These threaten to dismantle the NHS and replace it with a more costly, fragmented, and less effective system of care that is driven by profit in place of the public interest.