UK. Review of health policy since 1997

Citation

(2002), "UK. Review of health policy since 1997", International Journal of Health Care Quality Assurance, Vol. 15 No. 5. https://doi.org/10.1108/ijhcqa.2002.06215eab.007

UK. Review of health policy since 1997

UK

Review of health policy since 1997

A review, published by the King's Fund, says that health policy in Labour's first five years in government leaves "an overwhelming impression of relentless, almost hyperactive intervention". Five-year Health Check, edited by John Appleby and Anna Coote, shows that the Government has introduced many new policies since 1997, trying to iron out health inequalities, raise care standards, improve NHS productivity, increase responsiveness and extend services.

The review says that there is no doubt about the Government's commitment to a national health care system available according to need and funded through taxation. It has led an unprecedented drive to put more resources into the NHS, by increasing funding, tackling longstanding staff shortages and making increasing use of the private sector. However, Labour has not yet developed a coherent and principled set of criteria to guide its decisions. Its rhetoric is often radical, but its actions, however plentiful, are essentially conservative. The Government's reforms of long-term care have failed to mend a rickety system, leaving both users and carers dissatisfied. It has entered into a massive hospital building programme with the private sector, without a clear assessment of how future needs will be met, and without transferring any substantial risk.

Rabbi Julia Neuberger, King's Fund chief executive, said: "as it approaches its fifth anniversary in Government, Labour has a lot to be proud of. It has shown real commitment to a publicly funded NHS and to improving people's chances of living healthily.

"But investment and reform have been a double-edged sword. The NHS is overwhelmed with well-meaning policy directives, must-do targets and structural changes. Primary care trusts in particular are struggling to meet all of the policy imperatives Labour has set them."

She added that if Labour really can turn around the long-term trend towards widening health inequalities, it would have made a remarkable achievement. However, she said it was evident that there are conflicting tendencies in Labour's health policies, which must be resolved if Labour is to avoid storing up problems for the future.

Five-year Health Check reviews health policy since 1997 in ten key areas, including NHS funding, quality assurance and the reorganisation of primary care services. It concludes that Labour has achieved some important and far-reaching reforms, not least setting up new organisations to improve the quality of care patients receive and opening up access to primary care, for example through NHS Direct.

However, there are also serious gaps. Too much store has been set on structural solutions to problems caused by decades of under-investment and over-centralisation.

The report concludes that the Government is travelling in the right direction, towards a more robustly funded NHS, improved standards of health and social care, more patient-centred services and a system that is trying to reduce health inequalities. But it has raised public expectations of the NHS, putting it under enormous pressure. It recommends that the Government should now:

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  Keep the money flowing, but dispelany remaining illusions that money alone will save the NHS.

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  Stop the incessant flow of orders from the centre, build the morale and confidence of the workforce, and enable them to take ownership of the reform process.

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  Have fewer, broader targets for the NHS, which are costed and funded appropriately.

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  Give a higher priority to improving health and reducing health inequalities.

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  Prepare the public for the long haul: stop making heroic promises and buckle down to the unglamorous detail of building a good-enough health system for the twenty-first century.