Is Health Care in England Really on the Road to Privatization?

In 2010 the Conservative led Coalition government promptly set about reform of the English NHS. Opponents denounced the resulting legislation, the Health and Social Care Act of 2012, as hastening the beloved NHS towards privatization. This was now a familiar refrain as a number of reforms from the late 1980s onwards had provoked the same critique. This paper asks whether the HSC, building on those previous reforms, did finally set health care arrangements in England on the road to privatization. This question raises the conceptual problem of measuring change, which is particularly problematic in the multi-tiered field of health policy where “privatization” means different things to different stakeholders. In order to provide an organizing framework this paper combines the literature on policy change with that on health care systems. The latter literature has identified three dimensions of health care arrangements: The financing of care, the provision care, and the regulation of care. The paper suggests that the HSC, building on previous reforms, reinforces the emergence of different policy trajectories with regard to privatization across these three dimension