Keele Research Repository

The new White Paper, Integration and Innovation, prefiguring a Health and Social Care Bill for England, means that the NHS structure in England will have come full circle in the last 32 years, since the Thatcher government began in 1989 to implement the reforms announced that year in the White Paper, Working for Patients (incidentally without waiting for parliamentary approval, which came in 1990). This will be denied by some, who will depict the 'new' integration as only being possible as a result of learning during the various phases of reform over the last 30 years. This is a fallacious teleology. It is argued here that, while the 'old' NHS of the 1980s (of course) required improvement, the persistent 'reforms' of the last 30 years or so have been based on political fads which have been both hugely expensive and, in the end, transitory and self-defeating.