‘Working for Patients’ the 1989 White Paper on the Health Service: An Over-Review and Commentary
| Author | D.A. Roberts |
| Published date | 01 March 1989 |
| DOI | 10.1177/014473948900900103 |
| Date | 01 March 1989 |
Teaching
Public
Administration:
Spring
1989
vol.
IX
no.1
pp.33-40
THE
•
WORKING
1989
WHITE
SERVICE:
AND
FOR
PATIENTS'
PAPER
ON
THE
HEALTH
AN
OVER-REVIEW
COMMENTARY
D.A.
Roberts
Department
of
Social
Science,
Manchester
Polytechnic
Introduction
After
several
years
of
increasingly
bitter
controversy
over
its
handling
of
the
NHS,
the
Government
in
1988
split
the
Department
of
Health
and
Social
Security
into
two
separate
departments
of
state.
The
new
Secretary
of
State
for
Health,
Kenneth
Clarke,
has
now
the
major
task
of
promoting
and
implementing
the
1989
White
Paper
on
the
Health
Service
'Working
for
Patients'
which
is
the
outcome
of
the
Government
review
of
the
NHS
set
up
in
1988.
The
task
can
be
likened
to
that
of
Kenneth
Baker
with
the
1988
'Education
Reform
Act'
- a
general
sentiment
in
favour
of
state-
provision
in
principle;
but
many
complaints
over
its
delivery
in
practice,
entrenched
and
largely
unsympathetic
professional
groups,
and
with
much
advice,
some
originating
from
Conservative
peers
and
MPs
and
think
tanks
particularly
on
the
right
of
the
party.
In
1988
the
problem
of
the
health
service
had
overtaken
unemployment
in
the
opinion
polls
as
the
major
political
concern
for
the
electorate.
The
cure
for
the
National
Health
Service
problem
is
seen
by
many
commentators
and
by
the
majority
of
polled
public
opinion
as
being
one
of
a
relative
shortage
of
money
compared
to
the
demand
and
need
for
health
services.
These
needs
have
increased
due
to
demographic
change
the
increasing
proportion
of
the
elderly
in
the
community
-
and
the
need
to
take
into
account
new
techniques
and
procedures
such
as
cervical
cancer
screening,
the
AIDS
programme,
and
high
technology
medicine.
This
article
will
review
the
main
themes
of
the
White
Paper,
and
its
eight
associated
working
papers,
and
by
way
of
conclusion
will
briefly
discuss
some
of
the
many
right
wing
prescriptions
for
Health
Reform
that
have
flourished,
particularly
in
recent
years,
but
which
are
rooted
firmly
in
the
economic
and
political
philosophy
of
the
New
Right.
The
White
Paper
has
made
tentative
but
perceptible
moves
in
this
direction.
A
critique
of
the
White
Paper
and
a
look
at
alternatives
from
a
centre
and
left
perspective
will
follow
in
a
later
article.
Why
the
Need
for
Change?
The
White
Paper
sees
the
proposed
changes
as
necessary
for
the
achievement
of
patient-centred
efficiency.
Despite
the
33
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