Public Matters NHS briefings
These briefings give an overview of current issues in health and social care and how they relate to the wider health policy landscape. We hope that you will share our briefings on social media and with other networks. All we ask is that you always include the authorship as Public Matters with a link to this site.
The context for all these briefing will always be:
- Current issues are part of a sequence of policy changes which have taken place over the last 30-40 years. This is not a simple case of the current government underfunding the NHS.
- The policy landscape around the NHS has altered over this time from being based on a government responsibility to provide services to the government as ‘single payer’ for a combination of public, private and voluntary sector providers. This matches Tony Blair’s desire to see the NHS as a kite mark and a funding stream.
- During this period, the public-sector ethos has been replaced by private sector metrics and a belief that only competition and financial incentive motivate people to work effectively and efficiently.
- This combination has created the space for the private sector’s representation both as lobbyists and as active contributors in the form of management consultancies to take an influential role in policy decisions and legislation.
- The visible consequences of these policies have been a shrinking of the NHS which has resulted in a greater market space for the private sector both as ‘NHS providers’ and outside the NHS. It is also in the process of changing the nature of the NHS itself into a second-class service for those who can’t afford to pay.
We believe that this has been a retrograde step in the provision of public services.
The NHS is more than just a structure for the delivery of healthcare. It is a social institution that reflects national solidarity, expresses the values of equity and universalism and ensures the duty of government to care for all, no matter how rich, no matter how poor. The experience of the last 70 years has demonstrated that when commerce and the market have been kept outside of the NHS, its costs have been relatively low when compared with other developed countries. The more the market encroaches on those services, the higher the cost – which bears out Bevan’s original concept.
Modern public policy should be developed to reflect both the values and ethos that drove the creation of the NHS and with an understanding that this is fundamentally a more cost-effective and efficient way of delivering this service.