13012025
Identify the most significant policy changes
since 1979 and account for those changes in Health
Ever since it was founded the National Health Service has been an important policy area for the Government. Before Thatcher no government was willing to undertake the task of reforming the NHS, due to fear of public disapproval. By 1979 the NHS could no longer manage to deal with all things medically possible. With new technology patients were being treated in more complex ways. In turn, this led to increasing expectations of the Health Service from the public. However, even Thatcher made only one small attempt of tackling this huge problem before 1989. Until this point increasing amounts of money were being ploughed into the NHS, with very few visible benefits.
Shortly after Thatcher and the Conservatives came to power in 1979 a scheme called ‘Community Health’ was introduced. Each profession and organisation was reviewed. It was decided that care should be moved to a community setting. Community nursing was examined and general practice and primary healthcare were reviewed. Thatcher’s Government issued this scheme to ease pressure from the central healthcare problems. Their solution was to set up smaller central medical centres in the heart of communities, with, ideally, smaller patient numbers and therefore smaller waiting lists. More money was put into this scheme than the NHS had seen before. In spite of the increased spending, increase in staff numbers and treatment of more patients, by 1987 health authorities all over the country were in debt, waiting list were growing again and hospital wards were being closed down.
Neither the public nor the health care professions were satisfied and the NHS was increasingly under scrutiny in the media.
In 1989 Margaret Thatcher’s Government drew up the white paper ‘Working for Patients’, which passed into law as the ‘NHS and Community Care Act 1990’. This introduced the Internal Market, the second policy change and the biggest step towards reformation that the NHS had ever been faced with. The Government’s main aim was to reduce the cost of the NHS, so the Internal Market was planned to address such issues as; growing waiting lists, increasing the responsiveness of the service to patients and also to innovate and challenge the vast influence of the hospitals. Before the Act was passed in 1990, a monolithic bureaucracy had run all aspects of the NHS. The internal market was set to change this. It created ‘purchasers’ and ‘providers’. The ‘purchasers’ were health authorities and some family doctors; these were given budgets to buy health care from the ‘providers’. The ‘providers’ were acute hospitals, ambulance services and organisations providing care for the mentally ill, people with learning disabilities and the elderly.
However, the Conservatives were convinced that in order for the NHS to be at it’s most efficient it was necessary to introduce free market forces. In other words the internal market was extremely ideologically driven and had more to do with the Conservatives adamant belief in free market capitalism, than the stated aims of reducing the costs of the NHS. In order to ‘reduce costs’ and ‘improve efficiency’ competition was needed. This competition was in the form of the ‘purchasers’ and the ‘providers’. Up until these reforms the budgets of the family doctors and the state hospitals were not published. However the new internal market made it possible to account for their finances.
The visible advantage of being able to find out the financial information of your doctor or hospital unfortunately came with two main disadvantages; although it was possible to find out all this information about your doctor or hospital the public still could not choose a different one without turning to the private sector. The second disadvantage was that the most vital information – their success rates were still unobtainable. These disadvantages quickly led to more scrutiny from the media, which in turn led to increasing mistrust for the doctors, hospitals and NHS in general. Mistrust can often lead to degradation of respect for doctors, even though most doctors had very minimal say in the reformation of the health services.
Another point that has to be made is the accusations of a ‘two-tier system’ being in practice. This was the result of two types of GP practices being open. You either belonged to a fund holding GP or a non-fund holding GP. Depending on which type you belonged to you would receive a different quality of treatment – patients of fund holding GPs were often able to attain treatment more quickly than patients of non-fund holders. This was a clearly a breach of ‘equal treatment for all’, which was one of the founding principles of the National Health Service. At this point it was clear that the arguments against the NHS actually had factual basis.
In November 1990 the Conservative M.P.s voted Margaret Thatcher out of the office of Prime Minister. She was therefore forced to resign, and John Major was voted in to replace her.
Despite the disapproval of the public, John Major and his Government continued with the proposed reforms. The next policy change they made was to produce ‘NHS Trusts’. To become a ‘provider’ in the internal market, health organisations became NHS trusts; independent bodies with their own managerial systems, all in competition with each other. The NHS trusts came into being in 1991, of which there were fifty-seven. The growth was extreme and four years later all patients were treated by NHS trusts. The Conservative Government set up the trusts to try and organise the health care system and more importantly to try and organise it’s spending.
This scheme on the surface seemed to have redeemed the Conservatives. Spending on the NHS had actually increased under their power. Despite this by 1997 they found it difficult to move away from the impression that they were trying to privatise the NHS. This suited Labour very well, Tony Blair played on this in the 1997 election, when he famously declared to voters that they had ‘only 24 hours left to save the NHS’. Tony Blair won the election and with his ‘New Labour’ came ‘The New NHS: Modern, Dependable’.
When Labour came to power health was seen as the key issue for them, the public had high expectations for them to ‘save’ the NHS. However, they were actually exceedingly cautious in their election pledges for the NHS. Tony Blair and his Labour Government firstly made a pledge to abolish the internal market, the new government set out an approach, which, aimed to build on what had worked previously, but discarding what had failed. Shortly after this, a new white paper was issued by the Department of Health, titled ‘The New NHS. Modern. Dependable’. This put forward a ‘third way’ of running the service. The paper laid out plans to work alongside the NHS staff to overcome problems that arose with the internal market, building on previous plans to move away from outright competition to a more harmonious, collaborative approach.
Tony Blair and his Government have been following these plans ever since he came to power in May 1997. The changes from 1998 onwards broadly included financial and organisational changes and more importantly reversing old Thatcherism’s that failed to work.
In July 2000 the Labour Government drew up an ‘NHS 10 Year Plan’, this was to shift the emphasis on ‘patients always coming first’ and frontline staff having more responsibility. The next policy change came in April 2002, when the balance of power was shifted. It was set that 302 Primary Care Trusts (PCTs) were to replace old Health Authorities. Their new responsibilities included; programmes to improve health, reduce inequalities and integrate health and social care into communities, and to influence local agencies to ensure the widest participation in health care there had ever been in the UK.
Looking back at the facts, the 1970’s saw the rise of a more aggressive consumerism in the National Health Service, this continued throughout the 1980’s.
Klein (2001) in discussing the National Health Service reforms argued that:
“indeed one of the criticisms of the Thatcher administration was that it encouraged the public to regard themselves as consumers seeking to maximise their individual welfare, rather than as citizens seeking to maximise the collective welfare” (p.227).
According to Klein (2001), the 1991 policy changes were a ‘response’ to the downfall of the NHS, its changing environment and the increasing expectations from the public.
While on the surface it appears that health policies have changed considerably since 1979 there has merely been a shift in the structure of the system itself. Twenty two years later and it appears that Tony Blair has fallen into the fatal trap of believing that the NHS can be reformed if he carries on feeding more and more money into the system. This approach has failed to work in the past and it appears to be failing again now. However, in the current political and economical climate I personally doubt that Tony Blair will be willing to risk his Government to take on the hardest job of all; creating a British Health System that works.
References
Background information was gathered from the following:
- Carrier J and Kendall I (1998) Health and the National Health Service. London: Athlone Press
- http://www.psr.keele.ac.uk/area/uk/man/lab92.htm
- Klein R (2001) The new politics of the National Health Service (4th ed.). Harlow: Prentice Hall.
- Wall A and Owen B (1999) Health Policy. Eastbourne: Gildridge
The quotation on page number 3 is from:
- Klein R (2001) The new politics of the National Health Service (4th ed.). Harlow: Prentice Hall.
Word Count (minus references and quotes) = 1,458
Page Number
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