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Views & Reviews Review of the Week

NHS reforms caught in the act

BMJ 2012; 345 doi: (Published 16 July 2012) Cite this as: BMJ 2012;345:e4844
  1. Nick Seddon, deputy director, Reform, London SW1P 3LT, UK
  1. nick.seddon{at}

The story of how England’s Health and Social Care Bill came to be conceived and passed is pure drama, finds Nick Seddon

“And let me speak to th’yet unknowing world / How these things came about,” says Horatio at the end of Hamlet, seeking to make sense of the “accidental judgements” and “casual slaughters” through the act of storytelling. It is to this dramatic tradition that Never Again? appeals, with its mock-Jacobean frontispiece describing it as a “moderne drama In Five Incompleted Acts.” In fact this is a conceit, for it’s a work describing public policy making rather than fiction, but the narrative is unusually captivating. It tells the tale of how the Health and Social Care Bill—the most controversial piece of NHS legislation in over two decades—became law, and tries to ensure that lessons are learnt for the future.

The protagonist, the man with whom this legislation is uniquely identified, is the health secretary, Andrew Lansley. Just weeks after promising “no more top-down reorganisations,” he launched in July 2010 arguably the biggest restructuring the NHS had seen in its 63 year …

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