Most readers of this Journal will be aware that the United Kingdom's Conservative-led coalition government, on being elected in 2010, embarked on what it itself labelled as a radical reform of the National Health Service (NHS). Some contend that the original reform proposals were not particularly revolutionary; rather, they proposed building incrementally upon the reform efforts of previous governments. Consequently, the proposed reforms were considered by some to be evolutionary rather than revolutionary, although others might also balk at the evolutionary label, with its connotations of progress. In a much simplified nutshell, the kernel of the original reform proposals, crafted by the then Secretary of State for Health, Andrew Lansley, strongly emphasised the further development of provider competition and greater private sector involvement, but in the face of much opposition from stakeholders and from the Liberal Democrats, the Conservative's coalition partners, the process was paused for consultation. When resumed, owing to attempts to appease various stakeholder concerns, the Bill had a patchwork feel to it, with, for example, integration being emphasised aside competition. Analytically, the Health and Social Care Act that was passed in 2012 can be legitimately be viewed, somewhat generously, as messy and complex, and the political process that produced it a fiasco.

Many, perhaps most, have attributed the fiasco, assuming it can be defined as such, to Andrew Lansley, viewing him as a politically blinkered man on a mission. He had, however, misguided or otherwise, been developing his ideas for health sector reform for several years, and was appointed, during a period of economic crisis, by a Conservative leadership that had been out of power for 13 years. The Health Secretary may have sensed that there was a window of opportunity for him to impose and implement his ideas and to be remembered in the same breath in years to come aside the father of the NHS, Aneurin Bevan. There is little doubt that Lansley genuinely believed that his proposals would improve the NHS and, for him, there may well have been a feeling of now or never. More than one US President has, after all, been criticised for acting incrementally with respect to health care policy when a radical overhaul might have been both possible and desirable. The irony regarding Lansley's huge political commitment is that his plans were not really very radical and thus he might have been more successful at implementing them unmolested, had he adopted a lower key approach to policy reform.

Soon after the Health and Social Care Act was passed, Nicholas Timmins of the Financial Times, one of United Kingdom's foremost commentators on the welfare state, published a book that dissected the long process of how the Act came to be. The book, published jointly by the King's Fund and the Institute for Government, is titled Never Again? The Story of the Health and Social Care Act 2012. In the articles that follow, some leading NHS policy analysts, including Rudolf Klein, Julian Le Grand, Zachary Cooper and Calum Paton, reflect on Timmins’ book, although I think it is fair to say that Le Grand and Cooper do so through a lens that is almost the polar opposite to that used by Paton, which is interesting when one remembers the main bones of contention that the original proposals provoked. John Appleby, himself no slouch (to understate it) when it comes to analysing the NHS, then reflects on the commentators’ reflections, not from the perspective of, but as a representative of the King's Fund, which, as said, is one of the book's publishers. Nicholas Timmins then completes this special section with a few comments of his own.