In the pre-NHS days,
the poor were dependent on altruistic doctors, herbalists and charities
for their health care. Despite a sense of mission, for example at The
Royal Free Hospital, provision was inevitably patchy. In the 1830s
and 1840s the English Chartists started the first mass
working class movement towards democracy, equality and
collective ownership. It was only decades later
in 1918 at the end of the Great War (WW1)
was there universal suffrage (the right to vote)
within a party politics-based democracy.
Women only won the vote ten years later after a
prolonged civil disobedience campaign.
The newly enfranchised masses wanted social
justice, which the new Labour party was unable
to achieve in the economic climate of the inter
War years. World War II was the turning
point - with it came the beginnings of the welfare state, which
guaranteed a minimum standard of living for all
(Home Office,
2006: 38).
After the war, Attlee's Labour government
maintained and extended The Welfare State and
the NHS was set up to provide free health
services funded by general
taxation to anyone who needed it, including visitors to the country.
What is
there to debate?
- There is a
limit to the funds which can be raised by taxation. At
the time of writing this in Nov 2006, NHS staff are out of
the streets with placards about hospital and ward closures,
staff cuts and the fact that many NHS Trusts are in
financial crisis. So, the funding of
the NHS raises many debates,
which we will consider later.
- The history of the NHS is one of progressive
expansion. No
matter how the funds are raised, there will
never be enough funds to meet all needs - which
means choices have to made.
Advances in medicine and the escalating
costs of treatments mean that the choices
have to confronted and discussed.
- The NHS is a mammoth organisation which has
been difficult to administer from the start.
Complexity has been managed by assignment of
responsibility to geographic and functional
units. Successive governments have experimented with
different organisational structures to achieve
efficiency whilst maintaining quality. The
current organisational structure of the NHS should be reviewed and future options debated.
- The
distribution of responsibility involves the
allocation of funds. The formulae used
for allocating the NHS budget within
the organisational structure have also
aroused debate.
- Given the limitation of funds, there is a need
to adopt cost effective methods in
the management of health care. Cost
effectiveness can be achieved in various ways,
each
with winners and losers, introducing tensions
and a political dimension to the debates.
- Even from its outset, there has always been
some tension between Service and Profit
within the NHS. There is thus some debate
over how these tensions between vested interests
could be and should be mediated to deliver just
rewards to all stake-holders.
- The most important stake-holders are the
beneficiaries of health care - the
patients - and the people who provide
the funds - the tax payers.
Patients are no longer as united as
the deprived working class majority were sixty
years ago when the NHS was founded. Their
expectations as patients and as tax-payers
are not always consistent.
- The divergent perceptions and expectations of
electors shape the ideologies espoused by political
parties. Political parties are
increasingly driven by short-term votes rather than
their traditional ideologies. All
parties claim that the NHS is safe with them.
But, what do they mean by that - and at a
fundamental level, what do they mean by The NHS?
- In
general, the ideological divisions between the
major parties seem to be becoming more
blurred as they focus on the dwindling
proportion of likely voters in a society
which is becoming increasingly disenchanted
with the current party political democracy.
Meanwhile, the internal ideological divisions within
parties have become more significant in 2006. Within
New Labour there is a well publicised divergence between the
ideologies of the Prime Minister and those of his Chancellor
of the Exchequer.
Many observers complain of a drift away from
a parliamentary to a presidential
style of government under Tony Blair.
Election pledges are not always honoured and
popular sentiments are increasingly ignored. This means that a change in the leader can mean
a huge change in priorities - even if not in the
direction - of government. This can now happen
within any party.
-
Constitutional reforms needed to make
Britain a true parliamentary democracy are outside the scope
of this web. However, it is pertinent for debates about the future of the NHS
to consider whether the running of the
NHS should be divorced from party politics
and government intervention.
Even so, if the NHS continues as a Service it must have
Charter which defines its core set of
beliefs and values - i.e.
ideologies.
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