This book provides an in-depth analysis of the NHS reforms ushered in by UK Coalition Government under the 2012 Health and Social Care Act, arguably the most extensive reforms ever introduced in the NHS.
Contributions from leading researchers from the UK, the US and New Zealand examine the reforms in the contexts of national health policy, commissioning and service provision, governance and others. Collectively, the chapters presents a broader assessment of the trajectory of health reforms in the context of marketisation, the rise of health consumerism and the revelation of medical scandals.
This is essential reading for those studying the NHS, those who work in it, and those who seek to gain a better understanding of this key public service.
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What does it mean to love a healthcare system?
It is often claimed that the UK population is unusually attached to its National Health Service and the last decade has seen increasingly visible displays of gratitude and love. While social surveys of public attitudes measure how much Britain loves the NHS, this book mobilises new empirical research to ask how Britain loves its NHS.
The answer delves into a series of public practices – such as campaigning, donating and volunteering within NHS organisations – and investigates how attitudes to the NHS shape patient experience of healthcare. Stewart argues that these should be understood as practices of care for, and contestation about the future of, the healthcare system.
This book offers a timely critique of both the potential, and the dysfunctions, of Britain’s complex love affair with the NHS.
In Chapter 2 , I explored the public opinion data which shapes our understanding of public sentiments around the NHS. This chapter turns to the first of the four sets of practices through which this book seeks to explore Britain’s love for the NHS: the donation and fundraising of money to gift to the NHS. The UK NHS is enmeshed in complex relations with the voluntary and community sector, who may act as service providers, funders of innovation and research and, sometimes, funders of particular forms of provision ( Mohan and Gorsky, 2001 ; Powell, 2007 ). My
This chapter explores public campaigns which are oriented around ‘the NHS’, focusing on them as practices of care and contestation for the healthcare system. This framing of public campaigning departs significantly from a well-established mainstream within contemporary UK health services research ( Jones, Fraser and Stewart, 2019 ), in which public mobilisations around health systems are frequently understood as irrational, and essentially unhelpful obstacles to the ‘modernisation’ of the NHS. Campaigns to save the NHS, whether through actual demands or more
Volunteering in healthcare is a significant and longstanding public practice in the UK, considerably predating the NHS ( Gorsky, 2015 ). However our knowledge of this diverse and often informal set of practices is, perhaps inevitably given those characteristics, somewhat patchy. A major report in 2013 noted a ‘striking lack of information’ on the topic ( Naylor et al, 2013 ). This is typical of the wider literature on volunteering in general, with definitional issues alone complicating analysis ( Lindsey et al, 2018 ). The King’s Fund used surveys to yield an
An institution that often seemed to be a national problem – its history punctuated by crises and prophecies of impending collapse – has survived as a national treasure. Public support remains rock solid: political parties compete to proclaim their faith in the service and their role as guardians of its future. Klein, 2013 , p 305 In Britain we often tell stories about how much we love the NHS. London’s wry 2012 Olympics opening ceremony included an extravagant choreographed routine by British film director Danny Boyle. The ceremony featured (alongside
11 TWO The NHS in 1990 Introduction The aim of this chapter is to provide the context for the rest of the book, exploring the NHS in 1990 in terms of its organisational structure and dynamics at that time. In an institution like the NHS, where understanding history is important to get a sense of why particular structures were put in place or what kinds of relationships exist between policy-makers and staff, this necessarily involves going back before 1990. However, we attempt to include only the elements of NHS history that are most relevant to
137 six Managing in the nHS introduction Managers are now among the most high-profile actors of all those working within the NHS today. They are often cast as its villains. They do not cure people, as doctors do, or care for patients, as nurses do. Instead they are often accused of cutting services, or as taking up money that could be better spent on care. Managers are overheads in health organisations, blamed by politicians when budgets are overspent (BBC News, 2006a) or wards not clean (BBC News, 2001), and reviled by the media as being responsible when
113 five Funding the nHS introduction The third distinctive organisational feature of the NHS comes from the choice policy makers made at the time of its founding in terms of the way it would be financed. The general taxation method of funding health services means that those on higher incomes make a greater financial contribution to the cost of their treatment than those on lower incomes, but with no guarantee of better access or superior treatment. The principle of funding health services from general taxation is therefore redistributionary – the richer
On 29 August 2022, The Times published a story headlined ‘Britain falls out of love with the NHS: poll reveals three in five now expect delays’ ( Lintern and Wheeler, 2022) . The report was of a YouGov poll commissioned by the newspaper to explore public attitudes to the NHS. Notably, none of the reported questions asked about, or even addressed, love at all. Online discussion of this article among commentators leapt from statements of declining satisfaction to the end of the NHS, and the inevitable importation of ‘an American system of private medicine
