There are many conservatives resisting NHS reform who sincerely believe that recent reforms (and for that matter those of 2001-7) have fragmented what has always been an integrated NHS. For them the reason the NHS finds integration so very hard is because all these reforms have introduced fragmentation through relationships such as commissioning and competition.
This belief that the NHS was intrinsically integrated goes along with a belief that during the ‘good old days’ the NHS operated as a command and control organisation. The belief was that the NHS was essentially integrated because the person at the top, the chief executive, could tell everyone what to do – ergo the NHS must have been integrated.
