Health Policy in Britain / Edition 6

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Overview

The National Health Service is forever in the headlines. Critics Claim that it is in terminal decline, while advocates maintain that it is on the road to recovery following a decade of investment and reform.

In this new edition of his classic text, Christopher Ham provides a comprehensive and accessible assessment of British health policy and the NHS. He traces the development of health policy from the public health legislation of the nineteenth century, through the establishment of the NHS in 1948, and on to the reforms pursued by the Blair and Brown governments. The core of the text focuses on the politics of health care, and analyses the role of politicians, civil servants, pressure groups and the NHS itself in policy-making.

Health Policy in Britain draws on the author's unrivaled academic expertise and his experience as a policy adviser to provide a uniquely well-informed but critical analysis of both the substance of health policy and the processes of policy-making.

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Editorial Reviews

From the Publisher
Reviews of previous editions:

"Chris Ham is unrivalled in his ability to distil and synthesise complex policy developments and present them in a clear and digestible manner for non-specialists... Everyone with an interest in health policy should possess a copy of this book." — Ray Robinson, Health Service Journal

"It can be safely and warmly recommended as certainly the most up-to-date — and probably also the best — text available for anyone interested in Britain's NHS, and seeking a guide through the maze." — Rudolf Klein, British Book News

"Christopher Ham's book... is clearly written with little jargon and is admirably brief without being superficial." — J.A. Muir Gray, British Medical Journal

"It is hard to find a better textbook about health policy in Britain for students with little existing knowledge. However, it can also be highly recommended for readers who work in the NHS, but want to make more sense of the often confusing web of policies and imperatives. This book manages to synthesise a maze of material in a readable form and enlightens as well as informs." — Public Health

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Product Details

  • ISBN-13: 9780230507562
  • Publisher: Palgrave Macmillan
  • Publication date: 8/15/2009
  • Series: Public Policy and Politics Series
  • Edition description: Sixth Edition
  • Edition number: 6
  • Pages: 336
  • Product dimensions: 6.40 (w) x 9.30 (h) x 1.00 (d)

Meet the Author

CHRISTOPHER HAM is Professor of Health Policy and Management at the University of Birmingham, UK. He was Director of the Strategy Unit in the Department of Health between 2000 and 2004 and was awarded a CBE in 2004.

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Table of Contents

List of Figures and Tables xi

Acknowledgements xii

Preface to the Sixth Edition xiii

Abbreviations xv

Introduction 1

The structure of the analysis 2

1 The Development of Health Services and Health Policy 5

The origins of hospitals and medicine 6

Public health Services 8

Mothers and young children 9

Health insurance 10

Hospital services 11

The establishment of the National Health Service 13

The structure of the National Health Service 15

The NHS between 1948 and 1974 16

The reorganisation of the NHS 23

The reorganised National Health Service 25

Conclusion 28

2 Health Policy under Thatcher and Major 30

Increasing NHS efficiency 30

Making the NHS businesslike 32

Dealing with the funding crisis 34

Working for Patients 37

The reform of primary care and community care 38

Implementing the reforms 39

The Impact of the reforms 43

Streamlining the structure 45

Conclusion 47

3 Health Policy under Blair and Brown 49

The inheritance 49

The New NHS 51

The new structure 53

Implementation 55

The comprehensive Spending review 57

The NHS Plan 59

Shifting the Balance of Power 61

Delivering the NHS Plan 63

A return to the market? 64

The NHS Improvement Plan 66

The health reform programme 69

Gordon Brown and the NHS Next Stage Review 71

The impact of the reforms 72

Conclusion 75

4 Financing Health Services and the Rediscovery of Public Health 77

The growth of NHS expenditure 77

The Wanless review of the long-term funding needs of the NHS 82

Raising and spending money in the NHS 85

Public health and health improvement 89

What has been achieved? 95

Conclusion 96

5 Policy and Priorities in the NHS 98

The context98

Access and standards 99

Primary care 103

Pharmacy and dentistry 108

Acute hospital services 109

Cancer 112

Heart disease and stroke 114

Mental health 116

Learning disabilities 118

Older people 119

Children's services and maternity care 123

Health and social care integration 124

Priority-setting 126

Conclusion 130

6 Policy-making in Westminster and Whitehall 131

What is policy? 131

British central government 133

Parliament 135

The Prime Minister and Cabinet 137

Ministers, civil servants and special advisers 142

Relationships between departments 144

Outside interests 147

Pluralism or corporatism? 148

Conclusion 152

7 Policy-making in Scotland, Wales and Northern Ireland 154

Differences before devolution 154

Differences after devolution: 1999-2003 156

Devolution after 2004 161

Comparing performance 168

An assessment 170

Regional government in England 172

The European Union 173

Conclusion 174

8 Policy-making in the Department of Health 176

The Department of Health 176

The policy community 180

Pressure groups 183

Parliament and the mass media 185

NHS bodies 187

The Consultative machinery 189

Ministers and civil servants 190

Special advisers and the core executive 193

Industrial and commercial interests 195

The role of ideas 198

Changes in the Department 199

Conclusion 205

9 Implementing Health Policy 207

The organisation of the NHS 207

The regional tier and strategic health authorities 208

NHS trusts and NHS foundation trusts 210

Primary care trusts 212

Arm's-length bodies 214

The role of the DH 214

Professional influences on policy implementation 221

Policy-making in NHS bodies 224

The NHS today 229

Conclusion 231

10 Auditing and Evaluating Health Policy and the NHS 233

The context 233

Performance indicators and performance ratings 235

The audit explosion and the rise of the regulators 240

Evaluation by independent organisations and government 246

Health improvement 248

Access to health care 256

Conclusion 264

11 Power in Health Services 266

Pluralist theories 266

Structuralist approaches 267

Marxist theories 268

Concepts of health 270

Power, interests and ideology 273

Theories and practices 275

Conclusion 280

12 Looking Back and Looking Ahead 283

How good is the NHS? 283

The organisation and management of the NHS 291

Hierarchies, markets and networks 294

The role of politicians 297

The future demand for health care 299

Increasing efficiency in the NHS 303

Priority-setting or rationing 305

Political futures 309

Conclusion 312

13 Reflections on the Reform of the NHS: 11 Lessons for Policy-makers 315

Taking stock 315

Moving forward 324

Guide to Further Reading 327

Bibliography 331

Index 347

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