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Summary This article surveys historical writing on the British National Health Service since its inception in Its History of nhs essay focus is on policy-making and organisation and its principal concerns are primary care and the hospital sector, although public health, and psychiatric and geriatric care are briefly discussed.
The over-arching narrative is one of transition from paternalism and technocratic planning to market disciplines and a discourse of choice, and of the ceding of professional autonomy by clinicians to managers and to the state. Later sections consider evaluations of the service, starting with Webster's thesis that the NHS has been subject to prolonged under-funding, particularly under Conservative stewardship, then moving to assessments of the Thatcher, Major and Blair reforms.
Much of the historical literature on the NHS is contentious and opinions are sharply divided on the reform era since the s and the trajectories this has set for the future.
National Health Service, historiography, primary care, hospitals, welfare state, policy, financing Sixty years on, and the beginnings of the National Health Service NHS fade into history, its founders long dead and its early workforce slipping beyond the reach of oral testimony.
How should it be remembered?
For politicians who traffic in ideals and aspirations, the story is simple. How should the parameters of the subject be drawn? From History of nhs essay start, this public supply has dominated UK health services, with private insurance never exceeding 12 per cent population coverage.
The dominant genre has therefore been a top-down history of the politics of the service, whose dramatis personae are the politicians, officials, doctors, intellectuals and pressure groups driving the policy process.
Such a history is also, needless to say, highly contentious. Almost from the outset the NHS has acted as a lightening conductor for ideological fissure, for some an incarnation of social solidarity and distributional justice, for others the epitome of inflexible bureaucracy and paternalism.
Nor is this simply ideological, as scholars deploying psychoanalytic insights like to remind us. There are only three widely circulated texts spanning the whole of the NHS's existence. These are the concise political histories by Webster whose second edition closes in and Klein whose fifth edition extends toand Rivett's fiftieth anniversary study, which emphasises clinical and organisational matters alongside policy and is updated online to Webster is an academic historian who initially worked on early modern science studies, and in his political history he makes transparent the sympathies which he muzzled in the official publications.
His admiration goes to Bevan, he portrays Labour as the founder and protagonist of the NHS with the Conservatives always more reluctant stewards, and he attributes the failings of the service to chronic under-funding and botched administrative reforms. Beyond these core texts there is a huge range of other relevant material.
Primary care has a limited literature, the essays in the edited Oxford History of superseding earlier studies by Stevens and Fry. What follows, then, will by necessity be limited largely to the NHS's political history.
At its crudest the dominant story of the NHS today is of a fairly stable institution in its early decades, which then entered a period of sustained reform characterised by the incursion of market disciplines.
One explanatory framework sets this arc of change against the sweep of social transformation in Britain, from post-war collectivism to fully-fledged consumer society. Political economy approaches emphasise instead the vulnerability of the British welfare state within the context of national and global capitalism.
The shift to a service economy and rising prosperity undermined the old Labour electoral constituency, while the need to attract international investment pushed governments to adopt lower tax regimes and open up the public sector to business; waiting in the wings was the international health care industry, poised to benefit from trade liberalisation.
Pollock's work is the best known exemplar, arguing for the deleterious effects of market values and privatisation, and critical of the long march from integration to fragmentation, with the accompanying denigration of rational planning. First, the service was destabilised by the checks on spending following the oil shock, while the restructuring proved an ineffective panacea.
Then came the true turning point, the Thatcher era, with constrained expenditure, the assault on medical corporatism, the internal market, and all that has followed. Armed with these preliminary reflections, the initial discussion proceeds chronologically, identifying the periodisation around which the key themes and debates have emerged, then exploring these.
Here the focus is on policy-making and organisation and, given the constraints of space, it concentrates on primary care and on the hospital sector. At the same time, it briefly notes those areas of the service whose history stands apart from the central narrative.
The closing section surveys evaluative works and asks how these feed in to historical readings. Foundation The founding of the NHS is marked by debate over whether a broad consensus existed in favour of reform, or whether change was the outcome of conflict between progressive and reactionary forces.
The fullest descriptions of the political machinations leading up to the reform are provided by Honigsbaum and Webster. A key backdrop was the curb on government expenditure under the Churchill administration, after it became apparent that initial financial projections had drastically underestimated costs while suppressed demand surged.
Even though capital investment remained lower than in the s, major strides were made in developing the full-time consultant service. If Ham's case study is generalisable then it also appears that the potential of an integrated service to rationalise the distribution of staff was fulfilled.
Klein treats this as the apotheosis of paternalistic faith in planning, attributing its subsequent failures to the short-sightedness of both politicians and the BMA, who preferred spending on projects with more immediate gains.
The official history details the long deliberative phase which preceded this reform. Analysis of its gestation points to ministerial frustration at the slow development of community care facilities and the unresponsiveness of the RHBs to central policy goals for psychiatric hospitals.Published: Tue, 16 May This essay will outline and discuss the creation of the National Health Service in England.
It will focus on the events that contributed to the creation and development of the National Health Service. The name National Health Service (NHS) is used to refer to the four public health services of England, Northern Ireland, Scotland and Wales, individually or collectively, though only England's NHS officially has this title.
For details of the history of each National Health Service, particularly since , see: History of the National Health Service (England). This national honor society essay examples service may be useful as an additional help for applicants to see what kind of information is crucial for successful essay; however, it is also crucial to keep an essay personal and unique.
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Oct 19, · The British National Health Service – A Review of the Historiography Martin Gorsky * * Centre for History in Public Health, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.