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on 9 March 2005
This is an extremely well-written and though-provoking analysis of the effects of labour's healthcare policies, and obsession with targets and red tape, on the current state of the NHS. I would highly recommend that every doctor and nurse working in the NHS read this as it opened my eyes to the extent of the current situation and helped me understand how we got here in the first place. In the current political climate, where debate on healthcare has been put centre-stage since the case of Margaret Dixon, it is an important and necessary book to read.
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on 26 April 2010
Despite spending long years in opposition quite rightly defending the NHS, and winning the 1997 election in part on a promise to save it, New Labour developed a set of reforms that brought private interest into the NHS in a manner that went well beyond the already demented dreams of Margaret Thatcher. Allyson Pollocks brilliantly argued and well sourced book describes how this happened, the forces that were behind the "modernisation" policy, and the short term and long-term ramifications of it for the NHS, in a prose that is clear and comprehensible for the general reader.

When the Labour party was voted into office in 1997 there was absolutely no way that the vast majority of those who elected them were voting for this policy of piece-meal break-up and privatisation of the NHS. The Orwellian nature of the language that was used to mask the realities of the "modernisation" project; the plethora of public relations personnel and endless spinning involved; the bullying and cajoling of opponents of the reform (including Allyson Pollock herself) all speak volumes for the lack of any popular mandate. So much for British democracy.

Pollock details the growing effects of "modernisation" on many NHS services including hospitals, GP's, and long term care for the elderly, and makes a cogent case for the negative effects that the marketisations, commodifications, and privatisations have had on the viability of our National Health Service. In short, the private sector wanted, and largely got, a cut of the NHS's revenues to boost their turnover and profits without incurring even a minimal amount of risk. In a way it is rather reminiscent of the cost-plus contracts that the Bush administration awarded by the bucket load in Iraq. The whole edifice has undoubtedly been kept on it's feet by the increase in funding for the NHS - God alone knows what will happen as public spending stagnates in the coming years?

"NHS plc" is a damning indictment of the New Labour project, and contains more commitment to public service than Blair, Brown, et al exhibited in their thirteen years of power. Well recommended and vital reading.
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on 17 October 2009
If you only read one deconstructive critique of government policy and the NHS, make it this book.

Professor Pollock is unwelcome in Government circles- because she shines a spotlight on the inconsistencies (aka lies), ambiguities (aka favouring big business over NHS) and changes (aka policies doomed to failure even before they waste billions of taxpayers money) that have beset the NHS over the last fifteen years.

Since she originally wrote this book (and was rubbished by Gvt about much of the content), many of her predictions, insights and conclusions have been proven correct.

It should make your blood boil
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on 23 February 2006
A very important piece of work. Politicians have done their level best to rubbish the author and to some extent they have acheived their goal. The NHS was failing due to chronic under investment (£200 billion from inception according to the Wanless report), not due to the fact that it was a publically run service. It has probably been one of the most efficient public services in the world. The arguement that private companies do better is totally unproven and overstated. I work in a PFI hospital which gives 10% of its income to the private consortia every year (>£30 million). Not surprisingly, we are heavily in debt and have too few beds! This strangles the development of new services and new ideas - Business plans are just put on hold. The medical and nursing professions have let the public down by not uniting against these disastrous policies. Unfortunately the BMA and Royal Colleges are full of yes men awaiting their pensions and gongs. It's now up to the grass roots to spread the word about this book and salvage some of the NHS. Don't get me wrong, we do need a bigger private sector and we should incentivise the wealthy to go private, but the current system of giving public money to private companies is absolutley outragous. Good luck to Prof Pollock. The fact that MPs have tried to discredit her is a testemant to her vision and the truth. I am making my goal to inform as many people as I can about this book. Read it and make your own mind up - after spitting blood, you might just agree.
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on 25 June 2009
Allyson Pollock provides extensive, well researched evidence that exposes the truth behind the stealthy, costly and wasteful privatisation of the NHS.

Her book provides hard evidence to show that the way that the NHS is being "managed" wastes huge amounts of taxpayers money. This book shows why and how the many hard working NHS professionals are being badly served by a completely unecessary, ill concieved and fragmented bureaucracy and its so-called "managers".

Allyson shows how any why the present NHS management system is a bad deal for taxpayers and a bad deal for patients.

Here are some quotes:

"The NHS is being broken up into hundreds of competing trading organisations."

Allyson shows that this is being done to conform to the needs of the ill-conceived "internal market". Allyson also exposes the fundamental flaws that underpin the "internal market" concept.

So who wants the internal market and who benefits from it?

Well, you can expose the roots of any process by asking just two questions:
1: Who pays for it?
2: Who wants it?

The answer to Question 1 is easy: It is the taxpayer and the patients who pay.
The answer to Question 2 is not so clearly visible.

"The dismantling process and its consequences are profoundly anti-democratic and opaque. The catchphrases of 'public-private partnerships', 'modernisation','value for money','local ownership and the rest conceal the extent and real nature of what is happening; moreover, the complexity of health care allows the reality of its transformation into a market to be buried under a thousand half truths."

As a management systems scientist, I see this book as a companion book to The Greatest Railway Blunder by Adrian Vaughan.

Both books present many examples of problems that now take much longer (at vastly increased cost) to resolve than they did before privatisation. One of the root causes of the increased costs is the addition of many unnecessary and costly bureaucratic processes. And then of course there are the need to pay for expensive commercial financial arrangements and the need to allocate money for "profits".

In The Greatest Railway Blunder Adrian Vaughan skillfully explains (with many examples) that extra time is now required before any action is taken because the "interested parties" first have to have one or more meetings to decide "who pays" and they do this by first deciding "who is to blame".

The costly fiascos of NHS privatisation and Railway privatisation are both direct consequences of fragmenting a single public organisation into hundreds of smaller private companies who each have to employ managers, accountants, invoice clerks and lawyers and at the same time make profits. And taxpayers continue to pay.

It is less costly and more efficient to manage a single system with a single organisation than to manage the same single system with lots of smaller organisations. Pretty obvious really!

So I wonder why our Parliamentary champions of "efficiency" NOT seem to understand that fragmentation increases costs and reduces service quality?

If the MP's expenses scandal makes you mad, then the detailed evidence provided by these two authors will show you that the MP's expenses scandal is just the tip of a huge financial fiasco in the public sector.

Maybe the Daily Telegraph can get around to investigating this since they have done such a good job of exposing the "MP's expenses" scandal.
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on 27 September 2004
The National Health Service used to plan and fund to meet patient needs, providing free and fair access for all. But in this superb book, Allyson Pollock shows how Labour is destroying this great working class achievement.
Labour pushes the IMF, World Bank, European Union agenda of opening up all public services - water, energy, sewerage, telecoms, post and health - to private firms. So health care is becoming a commodity as in the USA, where billing and marketing make up 30% of health care costs. In the USA, fraud by health care companies totalled $418 billion in 1990-95. For example, Columbia/HCA (allegedly helped by the British consultancy firm KPMG) defrauded the government of $1.7 billion.
In 2004, Labour lifted the ceiling on health administration costs, which had already doubled, cutting clinical care budgets so that there are fewer beds in PFI hospitals. Labour excludes doctors, nurses and health professionals from hospital management, while welcoming failed businessmen.
Surgery performed in private hospitals costs 40% more than in NHS hospitals, because of higher costs and the overriding need to return a profit to the shareholders. Private borrowing is dearer too and the risks are not transferred to the private sector. Labour has arranged public spending data and NHS accounts to hide the huge amounts of public money going straight through the NHS to private companies.
In 2002, Labour privatised practice premises through the introduction of Local Improvement Finance Trusts, which shifted control of primary care services from GPs to corporations. And Labour has forced local authorities to divest themselves of all their social service assets, including long-term care for the elderly, ending equal access to equal quality of care for older people.
Labour uses dirty PR tricks to defeat public opposition - smearing public services, lying about the huge inefficiencies of market-based health and social care, overriding evidence, bullying and sacking critics. Like the Liberals and the Tories, Labour aims to destroy the NHS. There is an alternative, which we all know.
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on 3 February 2007
An excellent book. I couldn't put it down. It made me so angry when I read it - I just cant believe what direction the NHS is going in. Has changed my opinion of the Labour party from good to bad.
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on 29 May 2009
Everyone has an opinion on what is wrong with the NHS, and the solution to the continual problem of why pouring money into a vast industry doesn't improve its performance. Some say its really a perception issue, rather than one of how the NHS works in practice. Allyson Pollock's book is vital reading and gives a history of where the NHS came from and gives an insight into where it's going.

Along with Tony Robinson's views on the politics of the UK's biggest employer, the future looks unclear for patients if they're relying solely on the NHS to ensure really excellent healthcare provision.

From a personal point of view, a different approach to health which is more patient-centred needs to be adopted.... and soon.
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on 6 September 2008
Allyson Pollock's book takes us on a fascinating journey from the inception of the NHS in 1948 to the present day situation, and how the principles on which one of our most revered and envied institutions has been torn apart from the inside by bureaucrats, vote-grubbers and the just plain greedy.

AP reserves her most scathing criticism for New Labour and the almost religious fervour with which it has embraced private sector money to slice the NHS into smaller, 'profitable' areas, with not the slightest evidence that such measures would be profitable, or indeed effective. She writes about how the shiny new hospitals, or 'foundation trusts' if you would, trumpeted by this government as the future of health provision, have to survive by closing wards and cutting services almost the moment they are opened to pay for its board of directors and shareholders. One only has to stand in front of the University College Hospital at Euston, London, and a few basic calculations will tell you that this is unsustainable as a hospital, as the huge interest payments on the construction drain funds supposedly for patient care. It signifies everything that New Labour stands for, all style and no substance.

Hospitals of course make up only a fraction of the NHS remit, and Pollock casts her eye over long-term care of the elderly, which has now become a postcode lottery of means testing, as private companies swooped to buy up nursing homes, close the unprofitable ones, dump experienced staff in favour of cheap labour, and ensure that any patients that require real nursing care are quickly rejected as being too high maintenance ie money-losers.

One of the few areas which, as yet, the govt has failed to enable private firms to really sink their claws into is the primary care sector of GP surgeries. GPs have traditionally been not only the gatekeepers of the NHS but also the ultimate patient advocate for whatever treatment they required, and have been the most vocal opponents of the creeping privatisation. New Labour have responded in their usual way, by ignoring reasoned arguments and evidence, rubbishing them with falsified data, publicly denouncing doctors as greedy self-interested slackers (this from people who award themselves generous year-on-year pay rises while ensuring the public sector workers see their incomes cut) and feeding the popular media with GP-bashing stories every 3days to cover the massive waste of money spent on managers, management consultancy, private accountants etc etc.

Not that New Labour can be entirely blamed for the situation, as it is demonstrated how the process of privatisation began in the Thatcher years, at a time when all other national industries were being sold off at an astonishing rate. The failure of a privatised gas/electricity private sector to create open competition is clear for all to see, as companies far from competing, act in their own self interests to line the wallets of directors and shareholders, while the most vulnerable in society are squeezed to the limit. So shall be the fate of healthcare in coming years.

But why would any govt even choose to go down this path? What right minded person would be against ensuring the provision of the healthcare of society's most vulnerable? The answer can be seen in terms no more complicated than that of self-interest, as politicians rush to line up their post-government years as directors/chairmen of the very companies they helped make very rich while in power. Sadly there is little evidence that an incoming Conservative govt would be remotely interested in standing in the way of this 'progress'.

Happy 60th birthday NHS, you will be missed.
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on 20 February 2016
im a great fan of our nhs, know its not perfect, but for what we pay we get excellent health care, Was terrified when reading this book and what they have planned not just for the NHS, this affects all of our access to healthcare. WE need to fight for our nhs, for our children and grandchildren if not for ourselves. WE owe it to ourselves and to them
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