It has been argued repeatedly that British health policy in the 1990s had a number of similarities with that of the 1930s. This article, while accepting that a comparison of these two periods may be useful, argues that comparing policy in the 1950s with that in the 1980s and 1990s is even more illuminating. To demonstrate this the author outlines first the similarities in policy between the early and later periods, then the differences, and the events that led to each. These comparisons suggest that there is evidence of path dependency in British health policy, and although the United Kingdom appeared to break away from the policy path for a short time in the late 1980s, the changes proposed then do not appear to have been as radical as first suggested. Many of the issues highlighted in the 1950s seem to remain unresolved today.
Get full access to this article
View all access options for this article.
References
1.
PowellM.The ghost of health services past: Comparing British health policy of the 1930s with the 1980s and 1990s. Int. J. Health Serv. 26(2): 253–268, 1996.
2.
LoweR.The Second World War, consensus and the foundation of the welfare state. Twentieth Century Br. Hist.1(2): 152–182, 1990.
3.
WebsterC.Back to the thirties?Radical Commun. Med.19: 23–31, 1984.
4.
WebsterC.The Health Services Since the War, Vol. 1. HMSO, London, 1988.
5.
Public Records Office.Draft Cabinet Paper by Minister of Health. MH 77/30 A. London, June 1945.
6.
WebsterC.Conflict and consensus: Explaining the British health service. Twentieth Century Br. Hist.1: 115–151, 1990.
7.
RossJ. S.The National Health Service in Great Britain. Oxford University Press, London, 1952.
8.
MorganK. O.The People's Peace. Oxford University Press, London, 1990.
9.
GambleA.The Free Economy and the Strong State: The Politics of Thatcherism. Macmillan, London, 1987.
10.
HallP.Policy paradigms, social learning and the state. Comp. Polit. April 1993.
11.
OliverM.Social learning and macroeconomic policy making in the UK since 1979. Essays Econ. Business Hist. 14: 117–131, 1996.
12.
Walker-SmithD. GEN 677/1, PRO CAB 130/160. February 5, 1959.
13.
HamC.Health Policy in Britain. Macmillan, London, 1992.
14.
King's Fund Institute.Health Finance: Assessing the Options. London, 1988.
15.
Taylor-GoobyP.Public Opinion, Ideology and State Welfare. Routledge and Kegan Paul, London, 1985.
16.
Public Records Office.CC (57) 5th meeting. CAB 128.31. January 31, 1957.
17.
LoweR.Resignation at the Treasury: The Social Services Committee and the failure to reform the welfare state, 1955–57. J. Soc. Policy18(4): 505–526, 1989.
18.
WhitesideN.Creating the welfare state in Britain 1945–1960. J. Soc. Policy25(1): 83–103, 1996.
19.
TitmussR. M.Daily Herald, February 2, 1961.
20.
WebsterC.Conservatives and consensus: The politics of the National Health Service, 1951–64. In The Politics of the Welfare State, edited by OakleyA. and WilliamsS.. University College London Press, London, 1994.
21.
KavanaughD., and MorrisP.Consensus Politics from Attlee to Major. Blackwell, London, 1991.
22.
BirchS.Increasing patient charges in the National Health Service: A method of privatizing primary care. J. Soc. Policy15(2): 163–184, 1986.
23.
KleinR.The New Politics of the NHS. Longman, Harlow, 1995.
24.
HoweG.Conflict of Loyalty. Macmillan, London, 1994.
25.
Working for Patients. Cmnd 555. HMSO, London, 1989.
26.
LawsonN.The View from Number Eleven. Corgi, London, 1992.
27.
HillM.The Policy Process in the Modern State. Prentice Hall/Harvester Wheatsheaf, London, 1997.
28.
RidleyF.The new public management in Europe: Comparative perspectives. Public Policy Admin. 11(1), Spring 1996.
29.
KleinR.Learning from others: Shall the last be the first?J. Health Polit. Policy Law22(5), October 1997.
30.
WilsfordD.Path dependency. J. Public Policy14(3): 251–283, 1994.
31.
RoseR.What is lesson-drawing?J. Public Policy11: 3–30, 1991.
32.
MajoneG.Evidence, Argument and Persuasion in the Policy Process. Yale University Press, New Haven, 1989.
33.
Butler to Macleod, January 13, 1953. Department of Health, 94501/9/1. London, 1953.
34.
Committee of Enquiry Into the Cost of the National Health Service, Report (Guillebaud Report). Cmnd 663. HMSO, London, 1956.
35.
SmithAbel B., and TitmussR. M.The Cost of the National Health Service in England and Wales. Cambridge University Press, Cambridge, 1956.
36.
Public Records Office.Treasury Social Services Division File on the Guillebaud Report. T227.424. London, 1955.
37.
TimminsN.The Five Giants. Fontana, London, 1995.
38.
Department of Health and Social Services.NHS Management Enquiry: Report to the Secretary of State for Social Services (Griffiths Report). HMSO, London, 1983.
39.
Royal Commission on the National Health Service.Report. Cmnd. 7615. HMSO, London, 1979.
40.
Department of Health and Social Services.Inequalities in Health: The Black Report. HMSO, London, 1980.
41.
GlennersterH.British Social Policy Since 1945. Blackwell, London, 1995.
42.
PollittC.General management in the NHS: The initial impact 1983–88. Public Admin. 69, Spring 1991.
43.
ThatcherM.The Downing Street Years. HarperCollins, London, 1993.
44.
DayP., and KleinR.Constitutional and distributional conflict in British medical politics: The case of general practice, 1911–1991. Polit. Stud., 1992, pp. 462–478.
45.
ForsythG.Doctors and State Medicine. Pitman Medical, London, 1973.
46.
PowellJ. E.Medicine and Politics. Pitman Medical, London, 1966.
47.
EnthovenA.Reflections on the Management of the National Health Service: An American Looks at Incentives to Efficiency in Health Services Management in the UK. Nuffield Provincial Hospitals Trust, London, 1985.
48.
BrindleD.Soft shoe shuffle to the NHS shake-up. Guardian, March 27, 1991.
49.
SheldonT.When it makes sense to mince your words. Health Serv. J., August 16, 1990, p. 121.
50.
ButlerJ.Origins and early development. In Evaluating the NHS Reforms, edited by RobinsonR. and Le GrandJ.. King's Fund, London, 1994.
51.
RobinsonR.Checks and balances. Health Serv. J., July 8, 1993.
52.
StewartJ., and MarshK.Change in the management of public services. Public Admin. 70, Winter 1992.
53.
LightD.From managed competition to managed co-operation: Theory and lessons from the British experience. Milbank Q.75(3): 297–341, 1997.
54.
HamC.Contestability: A middle path for health care. BMJ, January 13, 1996, pp. 70–71.
55.
BlackD.Change in the NHS. J. Public Health Policy, Summer 1992, pp. 157–163.
56.
KleinR.Why Britain is reorganising its National Health Service—Yet again. Health Aff. 17(4): 111–125, 1998.
57.
Le GrandJ.Britain: Competition, co-operation or control?Health Aff. 18(3), 1999.
58.
BaggottR.Evaluating health care reform: The case of the NHS internal market. Public Admin. 75: 283–306, 1997.
59.
JohnsonN.Reconstructing the Welfare State: A Decade of Change 1980–1990. Harvester Wheatsheaf, London, 1990.
60.
SchefflerR.Culture versus competition: The reforms of the British National Health Service. J. Public Health Policy, Summer 1992, pp. 180–185.
61.
HarrisonS.HunterD., and PollittC.The Dynamics of British Health Policy. Unwin Hyman, London, 1990.
62.
PowellM.New Labour and the ‘new’ UK NHS. Crit. Public Health8(2): 167–173, 1998.
63.
CrinsonI.Putting patients first: The continuity of the consumerism discourse in health policy. Crit. Soc. Policy55: 227–239, 1998.
64.
PhillipsL.Hegemony and political discourse: The lasting impact of Thatcherism. Sociology32(4): 847–867, 1998.
65.
KleinR.The politics of ideology vs the reality of politics. Milbank Mem. Fund Q.62(1): 1983.
