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Book Review: A Question of Care: The Changing Face of the National Health Service

A Question of Care attempts to evaluate 'the adequacy' of the British National Health Service (NHS) in relation to the aspirations it was originally established to fulfil. These applications were 'to provide a system of free, universal and comprehensive health care which would liberate people, as far as possible, from worry of illness and disability'. Whilst this is insufficiently explicit to provide evaluation criteria, Davidson concludes 'that the main forces shaping the NHS today money and managerialism appear to be pushing it away from its original aspirations'. Money; of course, is the lack of it. Managerialism is exemplified by successive reorganisations, the Griffiths changes, and a performance indicator focus. According to Davidson, managerialism represents an inversion of ends and means, efficiency over effectiveness, and the NHS turning in on itself and away from the social context within which it operates. Davidson briefly presents the system changes and then applies them to his own District of Haringey. Haringey, in northern metropolitan London, has a poor 'east end' that includes Tottenham and a prosperous west section split by the King's Cross railway line. He describes the effects of lack of money on comprehensive hospital care, primary medical and nursing services, and especially on community care services so important to a deprived population such as Tottenham. He reports how the Haringey Health Authority focuses on performance indicators as required by the NHS, and yet the Authority has limited control over hospital care services, no control