Planning, Markets, and Hospitals

Planning, Markets, and Hospitals

Planning, Markets, and Hospitals

Planning, Markets, and Hospitals

Synopsis

Improving access to hospital services has been a goal of public policy for over 70 years, the means of which have changed over that period. Drawing on original research this study presents a systematic approach to the challenge.

Excerpt

Debates about hospital policy and the welfare state

In 1962 Enoch Powell launched the Macmillan government’s Hospital Plan for England and Wales (Ministry of Health 1962a). After nearly 14 years of the NHS, it appeared that at long last a committed effort would be made to improve the quality of hospital accommodation throughout the service and provide new facilities where they were most needed. In England and Wales the plan envisaged spending £500 million over 10 years, which would enable the provision of 90 new and 134 substantially remodelled hospitals. There was a parallel plan for Scotland. The result would be a national network of District General Hospitals (DGHs) of 600-800 beds, serving catchments of between 100,000-150,000 people. ‘Bed norms’ - ratios of the numbers of beds needed to population - were to be used to equalise the distribution of the hospital stock. The Plan also envisaged a role for facilities offering different levels of specialisation. The most complex services would be available in teaching hospitals; the DGHs would provide the normal range of general hospital treatment; and, though some 700 hospitals were to close, there was still to be a place for smaller hospitals, either in rural areas or as support hospitals, offering less interventionist care than the DGHs. A fuller outline of the Plan is given in Chapter 6, but Powell took the opportunity to present it as an (unparalleled) initiative, declaring that the government were planning hospital provision on a scale unimagined anywhere else, ‘certainly not this side of the Iron Curtain’.

The reference is apt, and ironic; by 1989, Conservative spokesmen were drawing legitimacy for the NHS reforms from the collapse of state socialism, and arguing that the time had come to sweep away an era of ‘monolithic, oppressive overplanning’. The implication was that such arrangements might have been appropriate in straitened post-war circumstances but their raison d’être had been undermined by economic and social changes. Henceforth, the future of individual hospitals would, it appeared, be determined by their competitiveness and managerial efficiency. Yet barely two decades before the national plan, conversely, it was asserted that the nation was not yet ready for full state ownership and control, and that some form of public-private mix could secure access to health services.

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