It has recently been argued that British health policy of the 1990s has a number of similarities with that of the 1930s. In other words, recent years have seen a return to earlier policies, which has been termed “back to the future.” The author critically examines these assertions under a number of themes: comprehensiveness, services free at the point of use, inequality, planning, coordination, adverse selection, and democracy. In many of these areas there is a good deal of similarity between the periods. Moreover, both periods appear to be inferior to the intervening period of the “classic” National Health Service. A different temporal pattern is observable in the area of democracy, where there appears to be a clear deterioration over time. However, in many ways, the ghost of health services past may return to haunt the future.
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References
1.
LoweR.The Second World War, consensus and the foundation of the Welfare State. Twentieth Century Br. Hist.1(2): 152–182, 1990.
2.
DigbyA.British Welfare Policy. Faber and Faber, London, 1989.
3.
MohanJ.Commercial medicine and the NHS in SouthEast England: The shape of things to come? In Health Care and the City, edited by EylesJ., pp. 41–64. Occasional Paper 28. Department of Geography, Queen Mary College, London, 1986.
4.
MacnicolJ.Democracy and health care. Twentieth Century Br. Hist.4(2): 188–196, 1993.
5.
GreenD. G.Working Class Patients and the Medical Establishment. Gower, Aldershot, 1985.
6.
JewkesJ.JewkesS.The Genesis of the British National Health Service. Basil Blackwell, Oxford, 1962.
7.
WhitneyR.National Health Crisis—A Modern Solution. Shepheard-Walwyn, London, 1988.
8.
WebsterC.Origins of the NHS: Lessons from history. Contemp. Rec., Summer 1988, pp. 33–36.
9.
WebsterC.Back to the thirties?Radical Commun. Med.19: 23–31, 1984.
10.
Great Britain. Working for Patients. Cmnd 555. HMSO, London, 1989.
11.
MohanJ.Privatization in the British health service: A challenge to the NHS. In The Sociology of the Health Service, edited by GabeJ.CalnanM.BuryM., pp. 36–57. Routledge, London, 1991.
12.
WhiteheadM.National Health Success. National Association of CHCs, London, 1988.
13.
LockS.Steaming through the NHS. In The NHS Review—What It Means, edited by the British Medical Journal, pp. 1–2. BMJ, London, 1989.
14.
PatonC.Competition and Planning in the National Health Service: The Danger of Unplanned Markets. Chapman and Hall, London, 1992.
15.
WebsterC.The health service. In The Thatcher Effect, edited by KavanaghD.SeldonA.Clarendon Press, Oxford, 1989.
16.
The national wealth (editorial). Guardian, July 4, 1988.
17.
WaltersV.Class Inequality and Health Care. Croom Helm, London, 1980.
18.
EcksteinH.The English Health Service. Harvard University Press, Cambridge, 1958.
19.
GriffithB.IliffeS.RaynerG.Banking on Sickness. Lawrence and Wishart, London, 1987.
20.
PlayerD.Barbour-MightD.Health For All: The Practical Socialism of the National Health Service. Tribune, London, 1988.
21.
LevensonR.Patients and the market in health care. Crit. Public Health3(1): 26–34, 1992.
22.
PearsonM.Health policy under Thatcher. In Policy and Change in Thatcher's Britain, edited by ClokeP., pp. 215–246. Pergamon, Oxford, 1992.
WhiteheadM.Is it fair? Examining the equity implications of the NHS reforms. In Evaluating the NHS Reforms, edited by King's Fund Institute/Policy Journals, London/Newbury, 1994.
25.
WoodmanR.The painful dilemma of who not to treat. Independent, March 2, 1993.
26.
DeanM.End of a comprehensive NHS?Lancet337: 351–352, 1991.
27.
SalterB.The politics of purchasing in the National Health Service. Policy Polit. 21(3): 171–184, 1993.
28.
BaggottR.Reforming the British Health Care System: A permanent revolution?Policy Stud. 15(3): 35–47, 1994.
29.
ButlerJ.Patients, Policies and Politics. Open University Press, Buckingham, 1992.
30.
HowellJ. B. L.Re-examining the fundamental principles of the NHS. In The Future of Health Care, edited by the British Medical Journal, pp. 1–7. BMJ, London, 1992.
31.
HigginsJ.The Business of Medicine. Macmillan, Basingstoke, 1988.
32.
Standing Committee C: NHS Bill, 18 June 1946, Cols 573–575.
33.
IliffeS.Strong Medicine: Health Politics for the Twenty-first Century. Lawrence and Wishart, London, 1988.
34.
CookR.Life Begins at 40: In Defence of the NHS. Fabian Society, London, 1988.
35.
JohnsonN.Reconstructing the Welfare State. Harvester Wheatsheaf, Hemel Hempstead, 1990.
36.
BirchS.Increasing patient charges in the National Health Service: A method of privatizing primary care. J. Soc. Policy15(2): 163–184, 1986.
37.
RevillJ.NHS patients made to pay £10 to watch television. Evening Standard, November 1, 1994.
38.
WebsterC.Problems of Health Care: The Health Services Since the War, Vol. 1. HMSO, London, 1988.
39.
PowellM. A.A Tale of Two Cities: A critical evaluation of the geographical provision of health care before the NHS. Public Admin. 70(1): 67–80, 1992.
40.
PowellM. A.Hospital provision before the NHS: Territorial justice or inverse care law?J. Soc. Policy21(2): 145–163, 1992.
41.
MorganJ.The voluntary sector and the National Health Service. In Yearbook of Social Policy, edited by JonesC.StevensonJ., pp. 107–121. Routledge and Kegan Paul, London, 1983.
42.
Le GrandJ.The Strategy of Equality. George Allen and Unwin, London, 1982.
43.
TownsendP.DavidsonN.Inequalities in Health. Penguin, Harmondsworth, 1982.
44.
PowellM. A.The strategy of equality revisited. J. Soc. Policy24(2): 163–185, 1995.
45.
HudsonB.Quasi-markets in health and social care in Britain. Policy Polit. 20(2): 131–142, 1992.
46.
MullenP.Planning and ‘internal markets’. In The Changing Face of the NHS in the 1990s, edited by SpurgeonP., pp. 18–37. Longman, Harlow, 1990.
47.
MohanJ.Back to the future? Commercialisation, creeping privatisation and funding the NHS. Radical Commun. Med.34: 4–10, 1988.
48.
TimminsN.Cash, Crisis and Cure: The Independent Guide to the NHS Debate. Newspaper Publishing, London, 1988.
BarrN.GlennersterH.Le GrandJ.Working for Patients? The right approach?Soc. Policy Admin. 23(2): 117–127, 1989.
51.
MeekC.Market madness: NHS reforms go bananas. BMA News Rev., February 1993, pp. 16–17.
52.
YatesJ.Why Are We Waiting?Oxford University Press, Oxford, 1987.
53.
HarrisonS.WistowG.The purchaser/provider split in English health care: Towards explicit rationing?Policy Polit. 20(2): 123–130, 1992.
54.
FreemantleN.WattI.MasonJ.Developments in the purchasing process in the NHS: Towards an explicit politics of rationing?Public Admin. 71(4): 535–548, 1993.
55.
HeginbothamC.Rationing. In The Future of Health Care, edited by the British Medical Journal, pp. 32–43. BMJ, London, 1992.
56.
Political and Economic Planning (PEP). Medical Care for Citizens. Broadsheet 222. London, 1944.
57.
Nuffield Provincial Hospitals Trust. The Hospital Surveys: The Domesday Book of the Hospital Services. Oxford University Press, Oxford, 1946.
58.
RivettG.The Development of the London Hospital System 1823–1982. King's Fund, London, 1986.
59.
HonigsbaumF.Health, Happiness and Security. Routledge, London, 1989.
60.
FoxD. M.Health Policies, Health Politics. Princeton University Press, Princeton, 1989.
61.
LeffS.The Health of the People. Victor Gollancz, London, 1950.
62.
HarrisonS.Competing for Health: A Commentary on the NHS Review. University of Leeds, Leeds, 1989.
63.
HughesD.Health Policy: Letting the market work? In Social Policy Review 5, edited by PageR.BaldockJ., pp. 104–124. Social Policy Association, University of Kent, Canterbury, 1994.
64.
PowellM. A.The changing blueprints of the British NHS: The White Papers of 1944 and 1989. Health Care Anal. 2(2): 111–117, 1994.
65.
Hansard, House of Commons, 422, 1 May 1946, Cols 271-2 (WebbeH.Sir).
66.
LewisJ.What Price Community Medicine?Harvester, Brighton, 1986.
67.
OakleyA.The Captured Womb: A History of the Medical Care of Pregnant Women. Blackwell, Oxford, 1984.
68.
DoyalL.The Political Economy of Health. Pluto, London, 1979.
69.
DaviesC.Hospital-centered health care: Policies and politics in the NHS. In Prospects for the National Health, edited by AtkinsonP.DingwallR.MurcottA., pp. 53–72. Croom Helm, London, 1979.
70.
CunninghamK.Working For Patients: The Government's Review of the NHS. House of Commons Library Research Division 89/8. HMSO, London, 1989.
71.
HamC.Health Policy in Britain. Macmillan, Basingstoke, 1985.
72.
CrossmanR.The role of the volunteer in the modern social service. In Traditions of Social Policy, edited by HalseyA. H., pp. 259–285. Blackwell, Oxford, 1976.
73.
KendallI.MoonG.Health policy. In Public Policy under Thatcher, edited by SavageS.RobinsL., pp. 103–116. Macmillan, Basingstoke, 1990.
74.
RobinsonR.Self governing hospitals. In The NHS Review—What It Means, edited by the British Medical Journal, pp. 31–33. BMJ, London, 1989.
75.
KleinR.The Politics of the NHS, Ed. 2. Longman, Harlow, 1989.
76.
RobsonW. A.Labour and local government. Polit. Q.24(1): 39–53, 1953.
77.
MacIntoshJ. M.Trends of Opinion about the Public Health 1901–51. Oxford University Press, London, 1953.
78.
ReganD. E.StewartJ.An essay in the government of health: The case for local authority control. Soc. Policy Admin. 16(1): 19–43, 1982.
79.
HunterD. J.Accountability and the NHS. In The Future of Health Care, edited by the British Medical Journal, pp. 24–31. BMJ, London, 1992.
80.
BlunkettD.Labour Attack Government Sleaze in the NHS (press release). Labour Party, London, 1993.
