The English National Health Service in a cold climate: a decade of austerity
Bibliographic record
Abstract
Introduction It has been claimed that the first half of the 2010–15 Coalition government was taken up with debate on the Health and Social Care Bill 2012 (HSCB), which was introduced by Conservative Health Secretary Andrew Lansley, while the second half was devoted to limiting the damage caused by the Bill and dealing with the effects of growing financial and service pressures in the National Health Service (NHS) (Ham et al, 2015: 1; Powell, 2016). This chapter examines the longer period of the cold climate of a decade of austerity in the English NHS, focusing on two broad moves. First, there was a broad move from the optimism of the NHS's 60th anniversary to the greater pessimism of its 70th anniversary. Second, there was a similar game of two halves based on the argument of Timmins (2018) of the rise and fall of marketisation and privatisation, with the Health and Social Care Act 2013 (HSCA) perhaps being the high-water mark of faith in ‘competition and choice’ as the key drivers of NHS reform, and the period since then seeing efforts to ‘work around’ the Act. However, in addition to the ‘constant’ of austerity, some things stayed the same, such as the continuation of inquiries into failings in the NHS, continuing inaction on social care and ‘policy retreads’ on issues such as prevention and integration. A tale of two birthdays This section focuses on the move from the optimism of the NHS's 60th anniversary in 2008 (under the Labour government of 1997–2010) to the greater pessimism of its 70th anniversary in 2018. In 2008, some ‘official’ accounts entered the celebratory birthday spirit, for example, according to then NHS Chief Executive David Nicholson: ‘the NHS is performing extremely well’. He continued that the NHS was on course to achieve the historic 18-week maximum waiting time by the end of 2008, and to meet challenging targets for reducing rates of health-care-associated infection. Mortality rates for cancer and cardiovascular disease had been substantially reduced, while access to GP and other primary care services was quickly improving. In its 60th anniversary year, public confidence in the NHS and patient satisfaction with the quality of NHS care were both at their highest level for years (DH, 2008a: 3).
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".