Power and Influence in the NHS: Oceans Without Continents PDF

Foreword

I was Geoff Meads's college tutor from 1970 to 1973. It is flattering a quarter of a century later to be asked by him to write the Foreword to his expert study, and to find that he is a professor too. His subject in this book, the modern NHS, seems to me every bit as complex and as difficult to grasp as the periods of history to which he refers.

He describes how the NHS has in the past decade moved away from central direction and planning structures towards local control centred on general practice fundholdings operating in an internal market. In the process, political conflict and power contests have been 'regionalized'. The underlying situation, which is outside the scope of this book, is that the allocation of scarce resources through a price-system responding to demand and supply, the normal commercial situation, is absent in health care, for whose consumers it is 'free at the point of sale'. Where there is no price constraint on demand, it becomes infinite. But since supply is not, demand is reined back by rationing, in the form of waiting lists and other devices. The internal market, the devolution of health care to local level, the importance of local initiatives, the variety of local practices, all of which Meads emphasizes, are, as I understand it, responses to this situation. They attempt to import enough of the discipline of the market into health care to make it adequately responsive to its consumers, while preventing escalation of its costs from forcing it into bankruptcy.

Together with social security and pensions, health care expenditure exerts a grip on the budgets of all western states similar to the grip which defence exerted during the Cold War. Meads hints in his interesting study that UK efforts to resolve this problem have proved superior to those of other European governments; and promise to do so in the future. The combination of effective administration and financial constraint which he describes is one of which the great Sir Robert Walpole, to whom he refers in Chapter 2, would have firmly approved.

Author: Ian Banks