The NHS at 75: The State of UK Health Policy

In its 75th anniversary year, this book examines the history, evolution and future of the NHS. With contributions from leading researchers and experts across a range of fields, such as finance, health policy, primary and secondary care, quality and patient safety, health inequalities and patient and public involvement, it explores the history of the NHS drawing on narrative, evaluative and analytical approaches. The book frames its analysis around the four key axes from which the NHS has evolved: governance, centralisation and decentralisation, public and private, and professional and managerial. It will address the salient factors which shape the direction and pace of change in the NHS. As such, the book provides a long-term critical review of the NHS and key themes in health policy. Front Cover The NHS at 75: The State of UK Health Policy Copyright information Dedication Table of Contents List of figures and tables Notes on contributors Foreword 1 The NHS at 75: an unfolding story Introduction The NHS through anniversaries Analytical axes of health policy Governing the NHS through hierarchies, markets and networks The public and private axis The centralisation and decentralisation axis The professional and state axis Evaluating policy success in 75 years of the NHS Evaluating the NHS Temporal Intrinsic Extrinsic Conclusion References 2 NHS governance: the centre claims authority NHS governance: a schematic history 1948: the fiduciary model of health policy Consensus management Management Internal market Department of Health The Blair governments The Lansley reforms COVID-19 Conclusion: rising claims of authority References 3 Health and care funding at 75 Introduction The funding settlement for health in England Out-of-pocket and private spending Government funding for the NHS in England A new financial settlement for NHS England Public health spending Workforce Capital spending Social care NHS funding after the pandemic Increasing capacity Social care funding after the pandemic Conclusion References 4 The devolved nations Introduction Devolved health policy Divergence Brexit and COVID-19 Northern Ireland Scotland Wales Conclusion Notes References 5 NHS at 75: general practice through the lens of access The GP contract Access as a lens through which to understand primary care Access theory: a new model Contemporary policy issues using an access lens Introduction Remote-first primary care Skill mix change in primary care Extended access to primary care services Conclusion Notes References 6 NHS hospitals and the bedpan doctrine: the first 75 years Introduction What doctrine implies Central control Responsibilisation Policies and events that have triggered the bedpan doctrine Consequences for NHS hospitals Central control Responsibilised management Workload Workforce Hospital infrastructure Private income Efficiency and performance Evaluating the bedpan doctrine and its consequences References 7 Quality and the NHS: fair-weather friends or a longstanding relationship? Introduction Quality: its definition and operationalisation in the NHS A brief history of quality in the NHS Making sense of quality in the NHS Quality ingredients without a recipe? Quality as craft or science? The (problematic) borrowing of quality improvement methods Quality and control Conclusion References 8 Improving health and tackling health inequalities: what role for the NHS? Introduction Health and health inequalities in the NHS The ‘classic’ NHS (1948–1979) Conservative governments (1979–1997) Labour governments (1997–2010) Coalition and Conservative governments (2010–2023) Analytical lenses and health and health inequalities Hierarchies, markets and networks Public and private Centralisation and decentralisation Professional and managerial Evaluation of health and health inequalities Temporal evaluation Intrinsic evaluation Extrinsic evaluation Conclusion References 9 NHS managers at a crossroads: part of the problem or the solution? Managers and management: definitions Management reform in the NHS: a brief history Reflections: mounting criticisms about the value of managers Assessing the evidence base Is the NHS over-managed? Managers: a self-serving elite? The contribution of NHS managers Conclusion References 10 Forgotten, neglected and a poor relation? Reflecting on the 75th anniversary of adult social care Introduction: social care anniversaries Analysis of adult social care policy and practice Hierarchies, markets and networks A mixed economy of care Centralisation versus decentralisation Professionals versus the state Evaluating success in social care Conclusion References 11 The NHS at 75 in comparative perspective Introduction The NHS in comparative context in 2019 How has the NHS changed? The pandemic response How does 2019 compare to 2000? How did the NHS in 2009 compare to both 2000 and 2019? The UK healthcare system in comparative perspective How does the analysis here compare to typology-based approaches to healthcare systems? Why does the UK have such poor health outcomes and such high preventable mortality? Conclusion Notes References 12 Our NHS? The changing involvement of patients and the public in England’s health and care system Introduction The historical development of patient and public involvement in the NHS in England Contemporary PPI: Healthwatch Local Healthwatch: between local responsiveness, and national inequalities Healthwatch and the COVID-19 pandemic Healthwatch and Integrated Care Systems Healthwatch in context: a more complex landscape of patient and public voice Conclusion References 13 After 75 years, whither the NHS? Some conclusions Introduction NHS anniversaries Analytical axes revisited The governance axis The public/private axis The central/local axis The professional/state axis The NHS at 75: taking stock Relative performance and health spending Workforce issues Looking to the future References Index