A National Health Service?: The Restructuring of Health Care by John Mohan

By John Mohan

This booklet contrasts the proposals of the Royal fee of the past due Seventies with the very varied set of priorities enshrined within the 1989 White Paper and describes how the alterations among the 2 records took place. It argues that the NHS reforms may be noticeable now not because the inevitable manufactured from technical advancements nor as a consensus reaction to narrowly managerial problems in the NHS, yet particularly as a part of a much wider political procedure in the direction of country provision of welfare. The ebook strongly emphasises the asymmetric geographical affects of post-1979 alterations, a subject often underplayed through analysts of social coverage, and attracts seriously on formerly unpublished fabric.

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12 A National Health Service? Finally, in terms of sources of funds, we should note several measures designed to transfer some of the burden of financing the service onto the individual and the 'community' as well as onto the commercial sector. The most important of these, at least symbolically, have been the increase in prescription charges by approximately 2300 per cent between 1979 and 1994, although in real terms the increase is much less; the introduction of charges for eye tests and dental examinations following the passing of the Health and Medicines Bill in 1987; and the encouragement given to health authorities to raise income for themselves either through increased private treatment or via income generation schemes?

What, therefore, of the impact of changes within the service? In attempting to evaluate the impact of the changes described here, the influence of a number of factors must be separated out and numerous caveats entered. Firstly, if patient throughput measures are a key performance indicator, technical innovation has permitted a growing proportion of operations to be treated as day cases, greatly increasing patient throughput. This may lead to a reconceptualisation of the role of the hospital: assuming the availability of adequate support services, there will be less need for acute hospital beds (and so another key statistic, bed closures, will assume less significance).

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.

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