• Join over 1.2 million students every month
  • Accelerate your learning by 29%
  • Unlimited access from just £6.99 per month

'The essence of a satisfactory health service is that the rich and poor are treated alike, that poverty is not a disability and wealth is not advantaged.' To what extent has Bevan's vision for the British national health service been realised?

Extracts from this document...


'The essence of a satisfactory health service is that the rich and poor are treated alike, that poverty is not a disability and wealth is not advantaged.' To what extent has Bevan's vision for the British national health service been realised? "Inequality in health is the worst inequality of all. There is no more serious inequality than knowing that you'll die sooner because you're badly off." (Frank Dobson/DoH, 1997 cited in Shaw et al, 1999) "Geographical inequalities have continued to grow... the worse off tenth of the population are 2.08 times more likely to die before age 65 than the best off tenth." (Shaw et al., 2001) A long history of analysis of health inequalities has continually stressed the role of socio-economic circumstances and location as causal factors (DOH, 2001). The sense of social injustice stirred by the link between poverty and ill health was a strong factor in the establishment of the NHS in 1948. In the same year, the UN Declaration of Human Rights enshrined access to basic standards of living to support both health and healthcare in international law (Pinch, 1997). Inequalities in health have remained a politically sensitive topic, to the extent that the Thatcher and Major Conservative governments of the 1980s and early 1990s rephrased the phrase 'inequality' with 'variation' when reluctantly discussing the issue (Benzeval, 1997). The election of Blairite New Labour in 1997 has returned the issue of health inequalities to the political limelight. Integral to Bevan's vision of the NHS was the concept of equity of service provision irrespective of income. An equitable health service may be defined as 'one that offers equality of access to health care to individuals in need', although the notions of 'need' and 'access' are themselves problematic (Dixon and Le Grand, 2003). For example, equality of access does not necessarily translate into equality of utilization as this may be mediated by cultural and socio-economic factors (ibid., 2003). ...read more.


According to Cooke and Hunter (1998), the implications of middle class opt-out are that 'a service for the poor becomes a poor service'. If an increasing number of the middle classes opt for private healthcare then they will be less willing to pay taxes to support an NHS they do not utilize which threatens the sustainability of the system (Cooke & Hunter, 1998). There is also a geographical element to the privatisation of healthcare, which has seen the largest growth in London and the South East. In regions of high levels of private healthcare provision, resource pressure is removed from the NHS facilitating a relatively higher standard of public healthcare services and thus reinforcing the health gap (Mohan, 1995). Therefore, in many ways the utilisation of private healthcare facilities contradicts Bevan's vision of equity in national healthcare provision. New Labour has been keen to espouse its commitment to equity in the NHS in several keynote speeches and policy documents (DOH website, 2004). In 2003, the government presented the Health and Social Care Bill which introduced the idea of NHS foundation hospitals which allows special status hospitals greater freedom over their budget, the ability to make independent decisions on investment and the type of services they would provide (Mohan, 2003). Foundation hospital reforms are archetypal policies of New Labour's 'third way' rhetoric which seeks to provide a mixed economy of public private partnerships, utilizing theories of market efficiency and private finance to enhance public services, in particular by increasing choice and diversity of service provision. Whilst the reforms have been presented as sensible and modest, it has been suggested that foundation hospitals threaten the equity of provision at the heart of the NHS (Pollock & Price, 2003). The TGWU has described the Bill as representing the 'backdoor privatization of the NHS... leading to a less equitable, two-tier health service' (TGWU, 2002). The Bill saw the governance of foundation hospitals transferred from the Secretary of State to independent corporations operating at a local level, which has serious implications for democracy and accountability (Pollock & Price, 2003). ...read more.


Black and ethnic minority schizophrenia patients also tend to receive higher doses of medication than white doses of patients with similar problems (BBC News, February 12th 2004). Discrimination in terms of inequitable access and standards of treatment has also been exposed on the grounds of age (for example, age-based rationing and the upper age limits for certain treatments) and sexuality (Age Concern, 2000; Scottish Executive, 2003). Many structural inequalities in NHS healthcare provision are reflected within the organisation itself, for example the 'snow-capped' nursing employment hierarchy where ethnic minorities tend to be at the bottom of the pyramid (Commission for Racial Equality, 2003). Disadvantages in the access and utilisation of the NHS may derive from a number of sources, including distance and transport, employment and personal commitments, voice and health beliefs (Dixon & Le Grand, 2003). It is therefore important to consider aspects of inequality in NHS healthcare beyond the question of income or class. In conclusion, Bevan's vision of equity in healthcare provision is far from being fulfilled. Over the past twenty years we have actually witnessed a step back in the achievement of this aim, which has been instigated by policies of rationalisation and privatisation. Cultural factors and wider social inequalities have served to aggravate these inequities. The reforms of the NHS since 1979 have been fuelled by political ideology, these decisions have not been independent decisions about organisational change and efficiency (Mohan, 1995). However, there is considerable evidence that it is inequalities income and not healthcare provision that accounts for the majority of inequality in health. Even if Bevan's vision of an equitable healthcare service was to be realised, this would be far from sufficient to prevent ill health on the grounds of poverty. A mild redistribution of wealth, an increase to benefit payments and improved security for lower paid workers are just a few examples of the wider economic interventions that would be required to tackle the greater problem of inequality in health. ...read more.

The above preview is unformatted text

This student written piece of work is one of many that can be found in our AS and A Level Healthcare section.

Found what you're looking for?

  • Start learning 29% faster today
  • 150,000+ documents available
  • Just £6.99 a month

Not the one? Search for your essay title...
  • Join over 1.2 million students every month
  • Accelerate your learning by 29%
  • Unlimited access from just £6.99 per month

See related essaysSee related essays

Related AS and A Level Healthcare essays

  1. Marked by a teacher

    History of the National Health Service.

    3 star(s)

    These improvements meant that people started to live longer. However for the extremely poor there was still no safety net to help them in old age and meant that medical treatment was not affordable to them at any cost. Even in a poor house or infirmary, medical treatment was crude

  2. Equality, diversity and rights

    to work within the setting a person must follow policies which is stated in the work area. This type of policy that the person needs to sign gives evidence of proof of who the person s and also a proof of showing that they will not discriminate against any one

  1. Describe key aspects of public health. Identify current patterns of ill health and ...

    Rash turns to pus-filled lesions that become crusty on the eighth or ninth day.) * Delirium * Vomiting and diarrhoea In 1717 inoculation of small pox was introduced to the U.K from Turkey. Edward Jenner realised that people that already hade cow pox never got small pox so he experimented variolation on a small chilled that had small pox.

  2. The provision of health and social care services adapt themselves in order to meet ...

    and the health and social care services, which will promote the effective support that a child needs. Targets One target which the government have made and wish to achieve by 2010 is that 'sure start' children centre are available to all young children in all regions of Britain, which is

  1. Unit 11 - Working in Health and Social care - SECTION B - SUBSECTION ...

    Also it is important for a midwife to maintain accurate, existing and timely care records, both written and electronic, and participate in training providing supervision, refering, if necessary the mother to other health professionals to meet the individual needs. The should gain the skills, knowledge and competence to act as

  2. Discuss the concept of Discrimination in relation to physical disability and mental ill health.

    In particular, those who were classed as mental illness often faced abuse and even exclusion from society. People thought the condition resulted from possession of evil spirits and people began to fear those with mental ill health. In later years hospitals opened to help those with mental illness but it

  1. Health and Social Care Unit 3 Health and Well being

    Service users are encouraged to take advantage of services which aim to prevent illness such as smear tests or immunisation. A doctor or nurse would aim to persuade the service user to have the test best suited to their circumstances.

  2. Health and Social Care Communication. Examples from work with a service user with ...

    I think the reason this happened is because I forgot to put her favourite music on in the background. I will remember to do this in the future. Throughout the interaction, I was constantly using body language and gestures very well.

  • Over 160,000 pieces
    of student written work
  • Annotated by
    experienced teachers
  • Ideas and feedback to
    improve your own work