Assignment An academic report using key political approaches, relevant facts, evidence and analysis (1800 words) Title: Past and present approaches to healthcare provision. Assessment criteria 2.Understand the role of the State and private sector in provision of Health Care 2.1. Discuss past and present approaches to health care provision. 2.2. Evaluate the relationship between State, private and complementary medicine and voluntary care.

Overview Past and present approaches to health care provision 20th century Political activism, social reform and national interest combined to produce the beginnings of Welfare reform. Social democratic government wanted to protect working and living conditions and improve the health of the nation. The Welfare State (1944) The aim was to produce a safety net from cradle to grave. THE NHS (part of the reform) There was much opposition, but Nye Bevan (social democrat) established the NHS in July 1948. The expectation was that demand would reduce as the nation got healthier. This did not occur and the role of each government thereafter was to tackle the costs of the NHS.

Old Labour Major areas for health policy BUT Changes (Cost) The social welfare ideal and the welfare state. (Old Labour) The birth of the NHS 1948 - State provision Expectations of reduced need. BUT Changes (Cost) Increase in chronic conditions caused by social and behavioural factors. A growing ageing population placing greater stress on an already overburdened National Health Service.

Perspectives recap Conservative view New Labour view Old Labour View Health care should be part of the free market economy. The State manages this process. Healthcare should be allocated to the best provider. New Labour view Rights and responsibilities. Everyone has a right to healthcare but the responsibility to mange their health appropriately. Health promotion Old Labour View The state has a responsibility for the healthcare of it’s citizens. Free at the point of delivery Invest heavily in NHS. Increase tax as everyone has a duty to help others.

Overview - approaches Health promotion Is a way to reduce demand Social democrat approach State provision Neo-liberal approach Health should be a business New Labour approach Rights and responsibilities The beginning of the NHS 1948 Expectations that when the major killer diseases were cured demand would go down. Better healthcare and medicines meant that people lived longer but often with long-term chronic illness. Therefore the problem for the NHS has always been to alter provision and reduce demand Alter provision Hospital to community care Private/voluntary and informal (complimentary) provision - mixed Health promotion Is a way to reduce demand

Key political phases for consideration Conservatives (neo liberal policy) Thatcher (1979- 90) Major (1990- 97) New Labour (Third Way policy) Blair(1997-2007) Brown (2007- 2010) Coalition - Cameron and Clegg (2010- 2015) Conservatives (neoliberal policy) 2015 -2016 May 2016+

Need to reduce the increasing cost of the NHS Political focus Need to reduce the increasing cost of the NHS REDUCE DEMAND Health promotion ALTER PROVISION (Complimentary) State Private Voluntary Informal

Alter provision Change the way that healthcare is provided and by whom REDUCE demand Try to make people more responsible for their own health to reduce pressure on the NHS. Through health promotion tactics Health education Raising awareness Screening and early detection Major Changes Allowing public, private and voluntary services to provide services alongside the state.

The Conservative neo-liberal approach to healthcare provision 1979-1997

“Society does not exist – only the individual” Neo-liberal approach ALTER PROVISION and reduce demand In the 1980s society a dismantling of healthcare systems, a focus on promoting better health and the introduction of privatisation. This can be seen as a withdrawal of the state from the public realm and is evidenced in a statement from conservative Prime Minister Margaret Thatcher: 1979-1990 (Conservative Power) “Society does not exist – only the individual”

Analysis The government, blamed inefficient management and structures within the NHS for the cash problems. Supporters claimed reforms brought increased efficiency and effectiveness, but opponents said they undermined the founding principles of the health service. The Conservative Governments oversaw radical reforms of the National Health Service (NHS) which created mixed views. Aims Reduce the role of government in health provision. Encourage private healthcare. Introduction of market mechanisms to health provision. Hospital to community care Privatisation/ voluntary and informal provision to be increased. Consumerism and choice Health promotion to be encouraged.

Neo-liberal Reforms Thatcher in the (Health Service Act 1980) encouraged people to use private medical services. Analysis However, the public remained committed to the NHS and grew concerned when waiting lists increased and wards closed. The National Health Service and Community Act of 1990 reformed both management and patient care by introducing an 'internal market'. From this Act Health authorities and GPs were to manage their own budgets. 1991 – the first 57 NHS trusts were established

Market mechanisms Buyers and providers (Not service) Health Authorities and GPs became purchasers (buyers). They had fixed budgets and were responsible for assessing local health care needs. They could choose between competing providers to obtain the best deal for patients. Contracts could be with hospitals and other health service organisations in either the public or private sector. At the same time, hospitals and other health services, such as mental health units, became providers. Hospitals were restyled as self-governing NHS Trusts, with their income depending on contracts with purchasers.

Privatisation and Private finance The aim of reform was to produce a more cost-effective NHS. As well as the internal market, contracting-out was introduced. This forced the NHS to put in-house services out to tender and award contracts to the lowest bidder. The Private Finance Initiative (PFI) (1992) saw private firms putting up the capital for major NHS projects to pay for the design, construction and operation of buildings and support services. Analysis Health unions complained that PFI was privatisation by the back door.

Hospital to community care The Community Health Care Reforms (1993) changed the way society cared for the elderly, mentally ill, physically disabled and people with learning difficulties. The claim was to release people from long-stay institutions and house them in the community where they could be more independent and have a greater say in how they lived and the services they used. Analysis Criticism from health and social care experts said that community care is more expensive than hospital care and changes were not properly funded and extra funding was not provided. Another Conservative reform was the abolition of free eye and dental check-ups in 1989.

Consumerism choice and the NHS John Major created policies which claimed to make health services more accountable to patients. They introduced hospital performance tables, and the Patient's Charter in 1992 to clarify health organisations' duties towards patients (and A Code of Practice on Openness in the NHS (1995). They also extended the control for Health Service Commissioners (1996). Analysis However this was criticised for reducing accountability by allowing hospitals to bypass Health Authorities.

Structural reform The eight English Regional Health Authorities were abolished in1996 and replaced with 100 new Health Authorities (HAs) which were claimed to reduce bureaucracy (paperwork and red tape) and improve services.

Evaluation of neo-liberal health policy The Conservatives argued that the NHS was 'safe in their hands' and that the basic principles of a universal and largely free health care service had been preserved. They claimed the reforms brought increased efficiency, effectiveness and consumer choice. Criticisms It is claimed the conservatives created a two-tier health system, where some patients of GP fund-holders got faster access to health care and where the NHS was starved of resources those who could afford to were encouraged to go private which undermined the founding principles of the health service.

More Critique Power has shifted away from democratic control to the corporate elite. Their power increases as they are paid to provide services and expertise for the government. As the Welfare State has been transformed by the economic policies of the New Right, the patient has been transformed by commodification into an object for exchange in the market. Health reforms appear to benefit the working class (patient choice) but have left the basic structure of inequality unchanged.

Social democrat approach State provision Formation of the NHS 1948 Cost increased year on year Social policy for successive governments then meant reduce demand and cut cost of provision. Neo-liberal approach Health should be a business Market liberals believe in the ‘Free market’ therefore health should become a business and competition should be encouraged. The Welfare State (1944) The aim was to produce a safety net from cradle to grave. It was anticipated that people would need less welfare as they became healthier and more well off. This did not occur Political policy for health Depends on who is in power Reduce demand The New Public health Health promotion New Labour approach Third way Rights and responsibilities Right to free healthcare responsibility to maintain health Health promotion Community and state responsibility Increase in chronic conditions caused by social and behavioural factors. A growing ageing population placing greater stress on an already overburdened Health Service. Alter provision Consumer choice Privatisation