The White Paper covered a wide range of proposals, which included change in the structure and management of health authorities, proposal of extension of the Resource Management Innitiative (Baggott, 2004). Most importantly, the White Paper led to reforms in internal market. Following the idea of Professor Enthoven, the government estabileshed divisions between purchasers and providers and resulted in NHS and Community Care Act (1990).
One of the key issues in development of health care is NHS and Community Care Act 1990, which estabilished the way how health and community care are appointed in the UK. It changed the way how it is cared for people within community and seperated ‘the funding bodies’ or purchasers, from the provider organizations (Raffel, 1997). It transformed internal structure, creating ‘internal market’, were local authority deparment purchase the necessary service from Health Authorities and Fundholders that act as providers. From then on, GPs and local halth authorities were given funds from the Department of Health (DoH) to purchase healthcare on behalf of their clients. In order to become a ‘provider’ in the internal market, organizations have to become NHS Trusts, ‘independent organizations with their own management, competing with each other’ (NHS History). Consequantly, the 1990 Act have brought potential benefits and according to Raffet (1997), the 1990 Act ‘consitutes the most controversial and far – reaching set of reforms yet undertaking’. From then on, the purchaser could choose a better value deal as well as recognize who was providing what services and the Health Authorities baed the purchase of service on the assess of needs of population which could possible lead to greater health services (Leathard, 2000).
However, the internal market revealed comlexity and drawbacks. Firstly, it was claimed that more public money been used to buy private services while purchasers disharged hopsital patients to community earlier in a bid to save some money, which made clear that internal market unlikely to survive without extra funding (Leathard, 2000). Hospital and Community Services could no longer rely on annual budget and had to compete with each other in business that lead to financial dificulties (Pollock, Talbot – Smith, McNakky, 2006). As a result 1990-1994, the 245 hospitals were closed in Engalnd and Wales. As well as this, studies have proved that competition in the market may actually have had a negative impact on the quality of care provision. Indeed, Propper, et al. (2008) conducted a study which looked at the death rates after treatment for heart atack before and after 1990s policy change and fund that the even though waiting lists may have been reduced, the quality of care during the competition was negative.
Furthermore, NHS White Paper ‘Working for Patients’ claimed that the main goal of the 1991 reforms would be ‘to give patients, wherever they live in the UK, better health care and greater choice of services available’ (1989). It was claimed that patents will have a wider choice of services to choose from, which affected waiting time. Indeed, in another study completyed by Sicliani and Martin (2007), found that were GPs offered five hospitals for patients to chose from, the waiting time was lower. However, providing with more choice is not always a case. As study conducted by Fotaki (1999) showed, both patents and purchasers claimed that the demanded information was not always available and they were experiencing less choice than before the 1990s reforms. However, it also recognised that, the purchaser / provider split had resulted in better care from providers as they began to take more ‘user friendly approach’ to health services than before in order to boost their sales.
In conclusion, it is hard to say wherther 1990s reforms had a positive or negative impact on health and social care as alone, or wether other aspects played big role too. Indeed, in the first three years of the reform, there was a dramatic increase in resources to the NHS, diffcult to distinguish if reform played or resources played better role in reduction ofwaiting lists and provsion of greater range of services (Le Grand, et al., 1998). There is not enough evidence to prove that quality of service was imrpvoed or deterioated by internal market, however it was soon abolished when New Labour won ellections in 1997, who claimed will be focussing on ‘quality and efficency’ instead (Baggot, 2004).
Referencing:
Baggott, R., (2004) Health and Health Care in Britain, 3rd ed. Hampshire: Palgrave Mcmillan
Birchenall, M., Birchenall, P. (1998) Sociology as Applied to Nursing and Health Care. Edinburgh: Bailliere Tindall
Carrier, J., Kendall, I., (1998.) Health and the National Health Service. London: Athlone Press
Fotaki, M., (1999). The Impact of Market Oriented Reforms on choices and information: a case study of cataract in outer London and Stockholm. Social Science and Media. 48 (10), 1415-32
Le Grand J, Mays N, Mulligan J. Learning (1998) NHS Internal Market. London: King's Fund, Present and into 21st Century. Cheltenham: Nelson Thornes Ltd
Leathard, A. (2000) Health Care Provision: Past
Moon, G., Gillespie, R., (1995) Society and Health: an Introduction to Social Science for Health Professionals. London: Routledge
NHS History, From cradle to Grave – the first 60 years of the NHS. Online. Available from [Accessed 24th October, 2013]
Pollock, A., Talbot – Smith, A., McNally, N. (2006) The New NHS: The Guade. London: Routledge
Propper, C, Burgess, S, Gossage, D, Competition and quality: Evidence from the NHS internal market 1991-9, ECON J, 2008, Vol: 118, Pages: 138 – 170
Raffel, M. W. (1997) Health care and Reform in Industrialized Countires. USA: The Pennsylvania University Press
Siciliani L, Martin S. An empirical analysis of the impact of choice on waiting times. Health Economics. 2007;16(8):763-79. 80
Working for Patients. (1989) Department of Health. London, HMSO
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svarai (student)
