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- Author or Editor: David J. Hunter x
NHS reform continues to be a topical yet contentious issue in the UK. Reforming healthcare: What’s the evidence? is the first major critical overview of the research published on healthcare reform in England from 1990 onwards by a team of leading UK health policy academics. It explores work considering the Conservative internal market of the 1990s and New Labour’s healthcare reorganizations, including its attempts at performance management and the reintroduction of market-based reform from 2004 to 2010. It then considers the implications of this research for current debates about healthcare reorganization in England, and internationally. As the most up-to-date summary of what research says works in English healthcare reform, this essential review is aimed at anyone interested in the wide-ranging debates about health reorganization, but especially students and academics interested in social policy, public management and health policy.
Recent years have witnessed a growing concern in the NHS to devise and implement policies which explicitly recognise that certain client groups and services should receive a higher priority. The paper points to problems arising from the formulation and implementation of the Scottish health priorities documents, drawing where appropriate on related developments in England. Three areas are highlighted for analysis: the policy ambiguity inherent in the documents; problems of collaboration in implementing the policies; and problems posed by central-local relations. The paper concludes that there is a need for a more sophisticated response to the present fiscal squeeze than simply defending the status quo and suggests that the squeeze could provide the necessary stimulus for change.
This book sets the scene for the series by comprehensively assessing and critiquing the current state of the public health system in England. It places contemporary challenges and concerns in their historical context, tracing the dominant influence of a medical paradigm on the public health profession and exploring how this has given rise to difficulties for those who subscribe to social or structuralist paradigms. The history of public health is marked by struggles between these competing perspectives and recent policy developments have pointed in contrasting directions. This chapter introduces the various issues that will be tackled in subsequent chapters.
This chapter considers in more detail definitions of public health and how these in turn influence conceptions of a public health system. It does so in the light of the varying, and often contested, views and assumptions as to what public health is, what its guiding values are and who actually conducts public health. The latter is connected to a consideration of the debates surrounding what is an increasingly diverse and complex workforce employed by, and working in, a variety of organisations and institutional arrangements. Public health activities give rise to political and ethical tensions, which are reflected in debates over the boundaries of ‘stewardship’, defined as the collective responsibility that governments assume for protecting the health of their populations.
This chapter charts in some detail the evolution of the public health system in England from 1974 to 1997, noting key features and policy developments. It presents an analysis of key shifts in the way that public health was understood, including the emergence of the ‘new’ public health in the 1970s and 1980s, following a series of international initiatives emanating from the World Health Organization (WHO), notably the Alma Ata Declaration, Ottawa Charter and Health for all strategy. The chapter assesses the dominance of public health medicine for much of this period and the challenges it faced from those who subscribed to political and ecological models of public health. These various perspectives underlay moves within this period to establish a multidisciplinary workforce embracing the breadth and range of public health concerns.
This chapter reviews the policy and organisational changes that have occurred since 1997 following a change of government. New Labour sought to accord a high priority to the health of the public and was strongly committed to putting both health improvement and health inequalities back on the policy agenda. An important symbol of this new policy emphasis was the appointment of the UK’s first ever Minister for Public Health. The chapter presents and assesses the various policy developments from 1997 to the present day, including the two public health White Papers of 1999 and 2004 respectively. It also examines other developments affecting public health within this period, including changes in the structure of the NHS, the relaunching of commissioning under the heading ‘world class commissioning’, and the policy shifts towards markets and choice in the provision of health and health care.
This chapter is structured around a series of issues that have currently come to the fore in the public health system, all of which have their roots in the history of public health charted in the preceding chapters. These issues represent the key policy and practice challenges facing the public health system as it moves through the twenty-first century. The discussion focuses on the following issues: the nature of policy formation relating to the health of the public; markets, competition and choice; commissioning for health and wellbeing; public health through partnership; and public involvement.
This chapter looks ahead to some of the key threats to the health of the public and the challenges facing a public health system in future. These include climate change and environmental concerns; the need for a concern for health and wellbeing to permeate a far wider range of policies, tasks and activities than at present and to become a priority for those working in fields that would not normally be considered relevant to public health; and the thorny and persistent subject of health inequalities, which, arguably, is more a matter of social justice than health policy. The discussion suggests that a strong and confident public health system will contribute effectively to meeting these challenges. The global economic crisis could also provide an opportunity to find new ways of making progress that does not compromise sustainability.
Partnership working has been a central feature of New Labour's approach to the delivery of health and social policy since 1997. A number of partnership-based initiatives have centred on reducing health inequalities and improving health. This article reports on the findings from a systematic review of the impact of partnership working on public health, and considers whether these partnerships have delivered better health outcomes for local/target populations. It finds that there is little evidence that partnerships have produced better health outcomes for local/target populations or reduced health inequalities.
The introduction begins with an outline of the relationship and dialogue between politicians, policy-makers and academics engaged in research, and argues that evidence-based policy often loses out to the views of policy-makers. It then sets out the purpose of the book, which is to use research on health service reorganisation in the UK over the last 30 years to explain what has worked best and how it might be incorporated into present and future health service reform. The introduction then sets out the authors’ method for reviewing research on healthcare reform and health reorganisation, and explains the ‘realist review’ approach employed throughout the text.
