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Health Policy and the Cuts

Since the policy of cutting public expenditure was announced by the government attention has tended to be focussed on the nature of the crisis that made such a policy necessary . Within this general discussion, the National Health Service has seemed to be one arena in which struggles against the cuts were capable of drawing together workers and consumers in common action to prevent the standards of health care from falling . The impression is often given that all the cuts in the NHS can be directly related to the particular crisis which faced the state in the mid seventies, and the various policies that were imposed at the time could be directly related to the cuts . This impression is misleading in certain respects however. Many of the best known struggles over the cuts have arisen not from short term policies applied in a crisis but from long term policies either deriving from plans for expansion or from problems that arose in this expansion. This is not to devalue the cuts campaign, which has clearly been of great importance in raising the consciousness and organisation of workers and consumers . On the other hand, a full understanding of these long term policies and the way in which they are related to fundamental perceptions as to the nature of the health service is necessary if conclusions are to be drawn about the nature of Health services within the state . This paper will fall into five sections . The first will point to essential features of the health service which provide the framework within which decisions about the development of the service were placed . The second, third and fourth parts will examine the policies of capital investment, resource reallocation and priorities of health care. A concluding part will discuss some of the issues that are raised by the coincidence of long term policy change and short term financial stringency .