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Never Say Never Again: re-forming and deforming the NHS

The value of this book, by the doyen of the UK’s health policy journalists, is that it shines a full-beam torch into the government’s skeleton cupboard of policy faux pas before there has been time to bury the recent health policy disaster under spadefuls of retrospective spin. One of Timmins’ key observations is that policy should resemble a well-aimed rifle shot rather than a carpet bombing. Well, this book – produced far quicker than self-styled ‘academic’ treatises and losing little in the process – aims a rifle shot at Coalition health policymaking, which hits the target, while the government is still dusting itself down from the bloody passage of the Health and Social Care Act 2012. Without using academic terms, Timmins illustrates how the policymaking, which led to the 2012 Act, came straight from the ‘garbage can’ (Cohen et al., 1972; Paton, 2006) – whence policy is non-rational even when it is not irrational – and therefore contains little order and more than a little ordure. That said, another of the book’s virtues is that Timmins eschews cynicism. Yes, he depicts the chaos and short-termism in the process of evolution from Conservative health policy documents of the mid-2000s through the Coalition agreement, the White Paper (Department of Health, 2010), the Health and Social Care Bill (Mark 1) and on via the infamous ‘pause’ in consideration of this first version of the Bill in 2011 to the final incoherent Act. However, he also depicts the vision of Andrew Lansley, the Act’s tortured guardian. This is the Conservative Health Secretary who claimed that, after his reform of the National Health Service (NHS), it will ‘never again’ need fundamental reform. As well as being arrogant, this sounds more than a little crazed. Therefore, for Timmins to hold out the possibility, that maybe – just maybe – Lansley will be treated by posterity as a hero rather than a villain in the zig-zagging story of ‘public sector reform’, shows that the author has achieved a well-nigh-impossible combination – an account of politics at its worst and yet sympathy for the main political protagonist. This commentator nevertheless sees that any such sympathy is of the sort felt for the Shakespearean tragic hero – brought down by flaws on his own side rather than by chance or malice. For those who find this analogy fanciful, I refer you to Timmins’ subtitle – A Moderne Drama in Five Incompleted Acts. And by