By John Mohan
This ebook contrasts the proposals of the Royal fee of the overdue Nineteen Seventies with the very assorted set of priorities enshrined within the 1989 White Paper and describes how the alterations among the 2 files happened. It argues that the NHS reforms could be obvious no longer because the inevitable made of technical advancements nor as a consensus reaction to narrowly managerial problems in the NHS, yet quite as a part of a much wider political process in the direction of nation provision of welfare. The booklet strongly emphasises the asymmetric geographical affects of post-1979 alterations, a subject often underplayed via analysts of social coverage, and attracts seriously on formerly unpublished fabric.
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Additional resources for A National Health Service?: The Restructuring of Health Care in Britain since 1979
Rising demands also follow from increased public expectations and from the increased capacity afforded by medical technology, not just in terms of encompassing a broader range of conditions, but also in terms of keeping people alive longer so that they survive to make additional claims on services in old age. Use of the retail price index (RPI) underestimates inflation in the health sector, and finally the health sector is very labour-intensive and the scope for increased productivity is consequently limited.
A related point is that earlier discharge places a greater burden on community services and relatives, whose assistance during convalescence is assumed. Yet the availability of primary and community care services varies considerably. Indeed a constraint on the implementation of the NHS reforms may well prove to be the inadequacies of community care, which may prevent the speedy discharge of patients (Chapter 5). The government has seen the rise in activity as an index of its success, but critics have argued that waiting lists are a key indicator of the extent to which the NHS is meeting needs.
The aim here, instead, has been to pick out the major dimensions of change in this period in a way that presents individual issues chronologically; individual chapters take up these issues in more depth. However, as well as describing the policy innovations that have been introduced, it is also relevant to present a summary of major statistical trends in the NHS as a context for the later chapters. Inputs: trends in health care finance Public debate and media coverage of the NHS has been polarised between government claims of record inputs (principally financial resources) and outputs (numbers of patients treated) and dramatic and alarmist reports of bed closures, lengthening waiting lists and occasionally patients dying for lack of treatment.