THE PUBLIC CONTROL OF PRIVATE HEALTH CARE
| Author | JOAN HIGGINS |
| Date | 01 June 1984 |
| Published date | 01 June 1984 |
| DOI | http://doi.org/10.1111/j.1467-9299.1984.tb00558.x |
218
PUBLIC
ADMINISTRATION
modem audit, could not live up to the very watchwords it was devised
to uphold.
PETER
WILMOTT
Departmental Planning Unit
HM
Customs and Excise
NOTES
1
'A
category staff are broadly equivalent
to
Administrative
Group
civil servants in the
UK
and
category
'B
staff
to
Executive Group civil servants.
THE PUBLIC CONTROL
OF
PRIVATE HEALTH CARE
The history of public regulation of the private market in he2lth care dates back
many years
-
at least as far as the Act for regulating private madhouses in 1774.
Since that time a wide range of measures designed
to
control private entrepreneurs
and the services and institutions for which they are responsible has evolved. They
cover technical matters relating to dangerous
drugs,
fire precautions and planning
requirements, as well as staffing levels and
so
on. The most important piece of
legislation in this field, however, is the 1975 Nursing Homes Act and its subse-
quent amendments. This paper evaluates the adequacy
of
this Act as the primary
means of monitoring and inspecting the expanding private market in health care.
The
1975
Nursing
Homes
Act
The 1975 Act, which covers the provision of nursing home care in England and
Wales, reflects a number
of
principles established in an earlier piece of legislation,
the Nursing Homes Registration Act of 1927. This latter was the outcome of more
than 70 years debate and controversy about how best to protect the interests of
patients in private institutions. By the early 1920s the number of beds in private
nursing and convalescent homes had risen from only 9500 in 1891 and 13000 in
1911 to 40000 (Abel-Smith 1964, 339). Although the nursing profession fought
long and hard for the compulsory registration and inspection of private homes
they were vehemently opposed by doctors who maintained that the State was
invading their 'professional secrecy'. They denied the existence of a problem and
claimed
to
be
'ignorant
of
widespread abuse' in private institutions
fop.
cit.,
340-342). The doctors did eventually relent on the question of registration but
wanted procedures which provided for medical representation on licensing
committees, the exemption from inspection of all nursing homes owned by doctors,
and the protection of medical records from scrutiny by lay persons.
On
all but
the last item, however, they were overruled and the 1927 Act established what
has become the framework for current powers of inspection and regulation.
The 1975 Nursing Homes Act, like its predecessor,
is
primarily concerned with
Public Administration
Vol.
62
Summer
1984 (218-224)
Zl
1984
Royal
Institute of Public Administration
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