Shifting the Balance of Power within the NHS: A Hybrid Policy as the Third Way

Abstract

The UK National Health Service (NHS) came into existence on 5 July 1948 with the aim of providing a comprehensive range of health services to all in need. After 50 years, it is still a unique example of social engineering. It is the only social service in Britain, which is comprehensive in scope in the sense of looking after the entire population. It is, furthermore, the only service that is organized around an ethical imperative. Finally, it is remarkable for its sheer size, complexity and heterogeneity: with one million employees, drawn from a variety of professions and representing a wide range of skills, it is the largest employer in the country. By international comparison too, the NHS is unique, centrally financed and directed, yet operating in the pluralistic political environment. Yet the NHS has undergone many structural changes since its inception in 1948, and forces for change in the NHS are increasing at an exponential rate. This paper addresses the relationship of health sector reform and large-scale organisational change in England since the election of the Conservative government of 1979. The paper will argue that the degree of change achieved to the organisation and management of NHS is high. It will also be argued that there is a clear similarity and conformity between the policies of the Conservative government and of the New Labour government (elected in 1997) in respect of health organizational reform. I will conclude that New Labour’s ‘third way’ in health reform is a hybrid of the Conservative’s managerial approach in 1979-1997 and Labour’s traditional philosophy of centralisation.