Commercialisation and Centralisation: Towards a New Geography of Health Care
It is easy to exaggerate both the extent of consensus surrounding the NHS (National Health Service) and the unity of the political forces which brought it about; after all, the Conservative opposition voted against the Bill introducing the NHS on its third reading, an almost unprecedented indication of a party’s total opposition to the principle of a Bill. In similar vein, it is also possible to underestimate the extent to which there has, since 1979 and especially since 1983, been a radical departure in health policy. The Government has persistently proclaimed its support for the NHS, and some commentators, for example Klein (1984), have been persuaded that the ‘reality of politics’, notably public support for the NHS and the influence of powerful vested interests, have prevented fundamental change. On this view, change has been marginal: administrative reforms, limited increases in funding, and small concessions to private health care represent piecemeal change which contrasts sharply with the strident rhetoric of at least some Conservative spokespersons (Klein, 1984). Here I extend the critique of Klein’s position developed by Davies (1987), for whom Britain is presently entering an age of ‘welfare pluralism’. If anything, Britain is entering an age of ‘welfare commercialism’ in which, while superficially little has changed, the ground has systematically been prepared for fundamental change in the concept of a comprehensive health service, the way this service is funded and managed, and the roles of private and public, formal and informal sources of care in such a service.
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