New Labours Radical Changes to Health and Health Care Policy - Assignment Example

 New Labour’s radical changes to health and health care policy The Labour Party introduced itself as New Labour leading up to the 1997 election. During this campaign Tony Blair vowed to reform the British National Health System (NHS), often reciting his own family’s experience. According to Blair, when he was 10 years old, his father suffered a stroke while, at this same time, his sister fell ill, each requiring hospital care for several years. Health care concerns are reportedly the reason Blair did not follow in his father’s conservative footsteps (Leathley, 1996). The promise of New Labour was to introduce radical changes to the NHS by pumping additional resources into the system and to reverse health policies of the previous Conservative government. This pledge to divert major sums of governmental funds into the health care system was political fodder for Conservatives and was a principle part of the Labour Party’s addition of ‘new’, an act primarily designed to pronounce a new philosophy and proclaim its eagerness to distance the party from past conceptions of socialist leanings. In many cases, the radical changes to the NHS espoused by new Labour followed Conservative concepts. These new policies have proven to be more of a massive evolution rather than a revolution. Still, what had been the most radical change to the organisation of the NHS since its 1948 inception; the 1991 reforms instituted into the NHS Act were eclipsed by the 1997 Act. This was especially true when considering the abolition of the internal market and the creation of Primary Care Trusts (PCT) which, when taken together, embodied an even more radical change than the earlier reform. This discussion examines the similarities and differences of New Labour as opposed to Conservative approaches to health care and the changes brought by the NHS Act of 1997. The distinction of ideologies between Conservative and Labour (right and left wing) continues its relevance concerning key philosophical divides and policy making matters in today’s political arena. A description that encompasses the principle divergence between the right and left political ideals is their respective stance regarding the perception of fairness. The right has historically leaned toward favoring policies promoting inequality while the left have a tendency to favor social equality in its policies. New Labour initially promoted itself during the 1997 election as the party for radical change, referring to its movement as the ‘third way’ uniting viewpoints of neo-liberalism and social equality (Mouffe, 2000, p. 108). Blair and New Labour have endeavored to completely realign the party’s political direction and its public identity into one of a neo-liberal description. This has certainly been the case as evidenced by New Labour’s implementation of its health care policies which have reflected the rightward trend of the party and marked its separation from old Labour concepts. There is a discernable chasm between Old and New Labour in many respects to the same degree as the one between New Labour and Conservative. Blair did as promised in that he and his party created a ‘third way’ in accordance with his conceptions regarding the most effective method of governing. Blair has suggested “the totalizing ideologies of left and right no longer hold much purchase” (Hefferman, 2000, p. 135). The New Labour regime assured that it would tear down and rebuild the Conservative NHS reforms of 1991 including revamping the internal market, doing away with the practice of general practitioner fundholding in 1999, introducing competition into the system and addressing unethical business procedures (Light, 1997). Indeed, Labour changed greatly the organisation of health care in Britain with the issuance of the new NHS in 1997, but radical change does not necessarily imply a complete overhaul of the system from the ground up. The Conservatives built a number of sturdy fundamentals upon which the new NHS could be re-constructed. The previous system was not wholly flawed and, according to the Labour Party, it approached the changes in a non-discriminatory method regarding what is effective and what is not (Department of Health, 1997). Those changes involved three important aspects of modernising the NHS: first, the abolishment of general practitioners (GP) fundholding and the internal market; second, the inclusion of all GP’s in collective decisions through Primary Care Groups (PCG) or PCT’s; and third, by continually attempting to improve timely access to medical care. Among the principal modifications introduced were the abolishment of the ill-conceived and poorly implemented internal market primarily because of the inequities and the expenditures associated with its administration. However, the separation of purchasers and providers was retained and the NHS Trusts were largely kept intact (Secretary of State for Health cited in Wilkin, 2002). The three most observable changes implemented by the Labour government were a radical departure from the Conservatives health care structure, yet it all built upon and/or modified existing policy. In addition, the Labour government augmented its NHS policies by making an effort to increase patient understandings of their privileges under the Act. The Patients’ Charter, a government supplied guideline to health care rights, contains, for example, the “maximum permissible time one can expect to wait to be seen in a casualty department or in an out-patient clinic, or the maximum time period one can spend on a waiting list for an elective operation” (Bhattacharya, 1997). Generally, hospitals have been close to meeting these standards which has led to a notable reduction in wait-times for surgeries. Although the Labour Government proclaimed the abolishment of GP fundholding and the internal market, this process had demonstrated in the past potential to generate expenditure savings. It is due to this potential that GP involvement continues but is now known by other descriptions. Health Authorities established PCG’s in 1999 consisting mainly of local practitioners accountable for managing budgets for populations in their community. Medical decisions made by local clinicians are viewed to be more beneficial than those made by the more removed Health Authority. The principal responsibility for the purchasing of health care was redistributed to 500 primary care groups which covered ‘natural communities’ encompassing approximately 100,000 persons. This responsibility evolved from what were “100 health authorities, 3600 fundholders, and 90 total purchasing pilots” (Department of Health, 1997). PCGs consist of about 50 community GPs along with nurses which decide the budget for practically all hospital and community health services for the area plus the cash limited portion (prescriptions and staffing) of general services. In addition to the benefits realised from local authorities making budgetary decisions for local communities, PCGs retain any savings from the budget surpluses. “Management costs of the health authority and fundholders (are) pooled, capped, and shared out between the health authority and primary care groups” (Department of Health, 1997). Having local health care professionals make cost management determinations seems a great advancement over the old system of distant Health Authorities making those decisions regarding the very personal matter of health care (Mays & Dixon, 1996). The new NHS has attempted to personalize medical practices generally by localizing medical responsibilities. What were solitary, isolated and inter-competitive medical practices are now required to group together to work for the common good and accept the collective responsibility for various duties involving purchasing and commissioning (Hine & Bachmann, 1997). This new communal system of health care is also intended to eliminate preferential treatment practices known as ‘two-tierism.’ GPs have sufficient incentive to participate in PCTs because these groups control the dispersal of funds for their area. Therefore, practitioners must become involved so they may have an effect on the amount of funds allocated to their personal practice. A possible downside to practitioner’s groups having this great responsibility is that GPs attended medical school rather than business courses and may not have the proper background for managing purchasing and commissioning effectively (Mays et al, 1997). In accordance with the massive restructuring of the NHS was the abolishment of nine NHS Executive Regional Offices and the substitution of about 100 Health Authorities with 300 PCTs. Additionally, 28 new lower-level institutions, called Strategic Health Authorities (SHA), which are responsible for managing the performance of PCTs, replaced these Executive Regional Offices initially. Created in 2002, SHAs regulate and monitor the quality of local medical services. Again, the Labour Party simply modified Conservative health care concepts but in a rather radical way. The recent reduction to 10 from 28 offices was reportedly for reasons of increased efficiency and reduced taxpayer costs. SHAs are responsible for the development of local health improvement programmes, intended to satisfy the local needs for adequate healthcare. In addition, these SHA members have been given consultant positions in NHS trusts and with it, the authority to influence decisions regarding investments and development. “[SHAs] have new statutory responsibilities to collaborate with other local bodies, including local authorities, other primary care groups, and NHS trusts, for example in developing a health improvement programme” (Miller, 1997). SHAs also act as a supervisory body monitoring while supporting PCTs and have authority to intervene if they falter. These are all logical developments but raise questions about the capacity of health authorities to take on these new roles, especially with a reduction in management resources. The Labour government’s revamped NHS has greatly diverged from the Conservative health care structure by its forcing of vital alliances within what was a fragmented system. The new NHS has endeavoured to foster a collaborative environment between the government, providers and patients instead of the antagonistic, competitive situation prior to 1997. The NHS under the Conservative Party’s watch was inadequately equipped to engage the integration of various entities essential for effective public health care. “People with multiple needs have found themselves passed from pillar to post inside a system in which individual organisations were forced to work to their own agendas rather than the needs of individual patients” (Department of Health, 1997). The new NHS is far from flawed but a merged, cooperative approach at least allows the opportunity for improved health care in the long-term. As a result of cooperative discussions between authoritative organisations and PCTs, additional reforms were introduced such as the patient choice initiative and Payment by Results. The health care reforms allow for the new NHS’s fundamental goal of supporting affordable, higher quality health care by ensuring that care providers compete for allocated funds, which are related directly to the quantity of patients that are treated within the care community. In an attempt to ensure that provider competition is based on speed of medical service quality and access instead of simply by costs, a fixed tariff system has been established which is unlike earlier NHS reform measures. The outcomes realised from Payment by Results are that “hospitals are paid for how many patients they actually treat, according to a national tariff. Foundation Trusts began using the tariff in 2004 and, from 2005, all trusts have used it for elective care, representing about 30 percent of activity” (NHS Confederation cited by Select Committee on Health, 2005). Non-elective and outpatient medical services are to be included by the tariff this year and, in 2008, 90 percent of significant inpatient, day-case and outpatient activity will be covered by this system. The new NHS establishes the concept of patient choice which is associated to Payment by Results. Patients are able to choose from different providers, including independent sector providers, after their GP has referred them for a hospital visit. Patient choice is anticipated to improve the level of service in all facilities because patients will choose hospitals with shorter waits and those that provide better service. Hospitals that are not of higher standards will be forced to improve service or lose funds under the Payment by Result system. This will create a competitive market for the government-funded health care system which is also open to the private sector on condition that these providers offer their services at prices comparable to the NHS tariff guidelines. The NHS mandates that patients obtain a GP referral in order to receive further specialized hospital treatments outside of primary care. GPs possess significant influence over their patient’s admission to supplementary health system resources, a function commonly referred to as ‘gatekeeper.’ The vast majority of patients (more than 90 percent) initially interact with the NHS through a primary care provider. GPs undoubtedly play a crucial part in the entire NHS as they are in close contact with patients and make decisions regarding their present and future treatments. In addition to saving funds, the government has declared “the main aim of these reforms is to strengthen PCT’s commissioning function, as larger commissioning organisations, similar in size to old Health Authorities, will have increased bargaining power, and can be better aligned to local authority services” (House of Commons, 2006). New Labour’s sweeping changes to the NHS were largely based, however loosely, upon the Conservative scheme and have attained laudable ground regarding the overall improvement of public health care in Britain. The collaboration of health care officials at all levels is widely held as a positive step in the right direction which is evidenced by a significant positive outcome of this strategy. The leading health care complaint in 1997, a lack of timely access, has experienced a radical change since then. The wait-time fell to a maximum of 15 months by 2001. At that time, the government announced an ambitious goal of a maximum six-month wait-time by 2005 (Labour Party, 2001, p. 22). In February of this year, the government claimed to have achieved this projected target. It reported that in 2005, 48 patients did have to wait longer than six months for their operation, but 36 of that number were English patients waiting for a Welch hospital. Though the pledge was not quite met, most agree with Health Secretary Patricia Hewitt who said the progress had been ‘dramatic.’ The government’s new goal has been set at 18 weeks (“NHS”, 2006). New Labour has indeed radically modified the NHS in many ways. An emphasis has been directed toward a fairer and faster delivery of service, one that is based on collaboration, not competition, attempts to proportion resources equitably and encourages improved quality of care. One needs look only at the end result to realize the enormous revolution, or evolution, governmental health care policies have experienced since the 1997 election. References Bhattacharya, Satyajit. (Jan.-March 1997). “Agonies of Reform: Changes in the British National Health Service.” Indian Journal of Medical Ethics. Retrieved 10 August 2006 from Department of Health. (8 December 1997). “A New Start.” The New NHS White Paper. Retrieved 10 August 2006 from Hefferman, Richard. (2000). New Labour and Thatcherism: Political Change in Britain. New York: St. Martin’s Press, Inc. Hine, C.E. & Bachmann, M.O. (1997). “What Does Locality Commissioning in Avon Offer? Retrospective Descriptive Evaluation.” British Medical Journal. Vol. 314, pp. 1246-50. House of Commons. (11 January 2006). “Practice Based Commissioning.” London: The UK Parliament. Labour Party. (1 March 2001).  Ambitions for Britain: Labour’s Manifesto 2001. Retrieved 10 August 2006 from Leathley, Arthur. (2 October 1996). “Father’s Stroke Changed Sons Politics.” The Times. Retrieved 10 August 2006 from Light, D.W. (1997). “From Managed Competition to Managed Cooperation: Theory and Lessons from the British Experience.” Milbank Quarterly. Vol. 75, pp. 297-341. Retrieved 10 August 2006 from Mays, N. & Dixon, J. (1996). Purchaser Plurality in UK Health Care: Is a Consensus Emerging and is it the Right One? London: King's Fund. Mays, N.; Goodwin, N.; Bevan, G. & Wyke, S. (1997). Total Purchasing: A Profile of National Pilot Projects. London: King's Fund Publishing. Millar B. (January 1997). “Nine-to-Five.” Health Services Journal. Vol. 12, I. 3.. Mouffe, Chantal. (2000). The Democratic Paradox. London: Verso. “NHS Reaches Waiting List Target.” (3 February 2006). BBC News. Retrieved 10 August 2006 from Select Committee on Health. (11 January 2006). “Current PCT Functions and Configuration.” Second Report: The NHS in England. The United Kingdom Parliament. Retrieved 10 August 2006 from Wilkin, David. (2002). “Primary Care Budget Holding in the United Kingdom National Health Service: Learning from a Decade of Health Service Reform.” The Medical Journal of Australia. Vol. 176, I. 9, pp. 539-542. Retrieved 10 August 2006 from < http://www.mja.com.au/public/issues/176_11_030602/wil10489_fm.html> Read More