Defending Health and Social Care: Rediscovering the Socialist Alternative - www.dhrsa.org.uk
This site, established January 2007, aims to draw together in one place key references and resources for the struggle against the 'neoliberalisation' of health and social care services. It does not see such provision as it stands as unproblematic, but the 'reforms', supported with little variation by all the main parliamentary parties and the most influential 'think tanks', are not the solution. Do send us your suggestions for other links and resources.
The marketisation and privatisation of public services are being argued for in terms of 'increasing choice' or 'introducing competition and contestability' but behind the scenes the policy is actually one of increasing the role and scope of private capital at the expense of collectively owned public services, long demonstrated to be be both efficient and fair.

last update: 31 March 2008

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The Principles of the NHS

Some key texts on privatisation and related 'reform' of health services
- Books and pamphlets
- Other sources
Key web resources for a properly funded system of public health and social services
Other useful resources on the broader (including international) context of the neoliberal attack on comprehensive public health and social care
Evidence
So what's the alternative?
Struggles

Defending Health and Social Care: Rediscovering the Socialist Alternative - www.dhrsa.org.uk

The Principles of the NHS

The NHS, with its focus upon care and service rather than profit and consumerism, is a contradiction of our age. And it is a contradiction that the New Labour leadership are no longer prepared to tolerate. Sally Ruane

There was recently a 'consultation' closed 16 March 2007 on "core principles for everyone providing care to NHS patients" (interestingly not Core Principles for the NHS - you can see which way things are expected to go). There is not a lot to disagree with there, but while 'free at the point of use' is highlighted, the precondition for protecting this principle, a seamless system of democratically controlled public services is not mentioned - indeed it notes "We will work in partnership and co-operation with others ... including in the .... voluntary and private sectors... " . .

The 'founding principles' of the National Health Service are often mentioned. They were:-

Comprehensiveness - is about a service covering and meeting all kinds of health care needs - from infancy to old age, not just for physical illness (mental health and wellness), preventative and curative.. Already there are threats to comprehensiveness. Now there are increasing reports of services being denied on cost grounds (see the KONP Patchwork Privatisation pamphlet for example). Dentistry is another example where NHS dentistry is increasingly hard to get.
Closely related to this was the principle of Universality - a service for all - on the basis of citizenship rather than either ability to pay or insurance scheme parameters. This meant also uniformity of quality - people should have access to equally good health care wherever they access it ('the best that medical skill can provide' as Bevan put it).
Free of charge - it would be paid for by the state (on the basis of redistributive taxation). Bevan resigned over 'co-payments' (prescription and other charges) and these have continued ever since (except in Wales from April 2007) - an unfair flat rate charge that goes against the principle of funding on the basis of (progressive) taxation. Whole sectors have been shifted into the private sector (much dentistry), or the social care sector where there are user fees (e.g. care for older people and disabled people*). It is worth noting that the tax system was redistributive in the 1940s and 50s - it is far less so now, so even before further 'reform' the system breaches this founding principle.
Equality - those with more resources (educational, money, etc) would get no better a service than those who were less advantaged. There have always been inequalities but a public system gives a better chance of combatting those than one based on the spurious model of the consumer choosing in a marketplace. Inequalities stem from the class character of British society, not from the inefficiencies of a public health care system. Since people do not have equal health care needs, the point is to have access on the basis of need and not any factor irrelevant to need.

* The intention isn't to argue here for the old institutional model of NHS care but to note the shift away from free services.

Some key texts on privatisation and related 'reform' of health services

Books and pamphlets

The following books set out what is happening by way of the stealth privatisation of the National Health Serivice. Lister and Sen provide excellent international contextualisations. Mandelstam takes a local case study perspective. Tudor Hart and Pollock focus largely on the NHS, exposing current policies and destroying myths. Some books are costly but could be bought by union branches and campaign groups, or get your public or NHS library to order them.

NEW: The ‘patchwork privatisation’ of our health service: a users’ guide A report by Keep Our NHS Public An excellent summary of the current (Jan 07) situation in the English NHS. summary full report "Unless this drive is resisted, a comprehensive and equitable health service will be a memory. To resist we must first understand what is happening to our NHS. This guide should help in that endeavour." Wendy Savage

Lister, J. (2005). Health policy reform: driving the wrong way? A critical guide to the global "health reform" industry. Enfield: Middlesex University Press. £buy

Mandelstam, M. (2006) Betraying the NHS: Health Abandoned. London: Jessica Kingsley. £buy

Pollock, A. M. (2004) NHS plc: the privatisation of our health care. London: Verso. (good treatment of the State's retreat from responsibility for older people and the profit bonanza for the private care industry) £buy

Sen, K Ed. (2001) Restructuring Health Services: changing contexts and comparative perspectives. London and New York: Zed Books. £buy

Tudor Hart, J. (2006). The political economy of health care: a clinical perspective. Bristol: The Policy Press. £buy

Other sources

Our NHS: privatisation by stealth Gail Cartmail, 21st Century Socialism: November 17th 2006

Healthmatters magazine: Special focus: markets in health care (Issue 54, 2006)

Red Pepper articles on the choice con trick (August 2004):

The illusion of choice
Anthony Arblaster
The talk about ‘choice’ in health provision is largely a distraction. It is designed to conceal the fact that what is planned is even greater reliance on private health provision. The Tories are pretty open about this. Labour is, as usual, more evasive.

Spoiling for Choice (1)
Marian Barnes
The Labour-Tory market model for extending choice in the NHS will inevitably result in a dramatic decline in service-user equity.

Spoiling for choice (2)
Veronica Beechey
It is perfectly possible to provide excellence, diversity, patient-centred care and a reasonable amount of choice within the NHS without introducing the inequalities, uncertainties and hassles that would inevitably accompany an ideologically-driven mode of patient choice.

In Place of Bevan? Briefing on the Health and Social Care (Community Standards and Services) Bill 2003 By Allyson Pollock and David Price. Catalyst briefing paper. July 2003

Enron NHS? Foundation Hospitals and the backdoor privatisation of the National Health Service A Catalyst Briefing Paper for the TGWU September 2002 Summary Full download

GATS, Privatisation and Health by Sarah Sexton

Evidence presented to the House of Commons Select Committee on Health regarding the introduction of Independent Sector Treatment Centres (ISTCs) into the UK health care system March 2006 - by Sally Ruane

Defending Health and Social Care: Rediscovering the Socialist Alternative - www.dhrsa.org.uk

Key web resources for a properly funded system of public health and social services

Keep our NHS Public: Campaign and information site
We believe that the most equitable and efficient way of providing health care is by... using the simplest and therefore most cost-effective system of administration of the NHS based on planning and co-operation rather than market forces.
New Statement on the NHS

The NHS Support Federation is an independent organisation that works to promote a comprehensive NHS, with equitable access and active public involvement. - good links to local campaigns.

NHS Together brings together all the health service unions and staff associations together with the TUC. It's a new campaign alliance of health staff. We want to raise the alarm at what is happening to the NHS and to press the government for honest and open discussion about its reform agenda. (but what are they actually doing?)

UNISON:

Keep the NHS working page - the introduction of a competitive healthcare market and the increasing involvement of the private sector... has led to the instability and financial debt faced by many hospital and primary care trusts.

UNISON's 5 Healthier options campaign

UNISON response to the Social Care White Paper - Our Health, Our Care, Our Say.

Positively Public - UNISON campaign for quality public services

In the Interests of Patients? The impact of the creation of a commercial market in the provision of NHS Care UNISON report Jan 2007

London Health Emergency Founded in the autumn of 1983, London Health Emergency is the country's biggest and longest-running pressure group in defence of the NHS.

C. Bambra, R. Barnes, D. Fox, D. King, S. Laughlin, R. Thara, A. Scott-Samuel & M. Winters (Eds.), UK Health Watch 2005; The experience of health in an unequal society. Politics of Health Group. Free Download

Socialist Health Association - affiliated to the Labour Party. Becoming more critical of the neoliberal turn in government health policy.
Fresh Start: A fresh start for the NHS - a new sense of direction to regain the confidence of patients, the public and NHS staff.
The Business Model What, under New Labour, exactly, is the National Health Service?
NEW: Submission to Darzi review.

Learning Disability Coalition interesting on the tightening of funding - a national campaign for adequate funding for learning disability services. Sign their petition. "We want to make sure the government provides enough public money so that people with a learning disability have the same choices and chances as everyone else."

The Right to Care campaign is a coalition of organisations who believe that all personal and nursing care should be free at the point of use.

Labour Party conference opposes health privatisation policies. September 28th 2006 21st Century Socialism report.

NHS Privatisation in England, associated with patient choice rights and new funding arrangements A reasonably non-partisan summary and evaluation from the International Reform Monitor "Although it is being portrayed by the government as just another step along an incremental road most ‘neutral’ commentators as well as implacable critics see it as something more substantial, potentially putting the NHS on a path beyond the point of no return – for good or ill."

Real choice in the health service An RCN discussion document

Patients’ legal challenges to NHS cuts/closures solicitor Richard Stein's briefing notes,

Defending Health and Social Care: Rediscovering the Socialist Alternative - www.dhrsa.org.uk

Other useful resources on the broader (including international) context of the neoliberal attack on comprehensive public health and social care

The market has failed: BMJ 2007;335 (1 December), Fiona Godlee - interesting piece that indicates a reduction in New Labour's enthusiasm for the entry of private capital to a marketised NHS, and links to market failures in the US system. However this may be rather over-opimistic, see The NHS in England: The operating framework for 2008/9 which maintains the momentum in splitting off PCT provider services (section 3.23). It continues to encourage use of the private sector, but now gives the responsibility for decision making to local commissioners (can you trust yours?) (section 3.27).

On social enterprise and the privatisation of health and social care. some brief notes to help read the government's policy enthusiasm for the third sector as providers of health and social care, from DHRSA See also these two briefings from AMICUS: 1 2

Individual Budgets - The Next Big Thing? UNISON briefing on Individual budgets, Nov. 2007 full report Individual budgets are particularly interesting since they combine an emphasis on user choice and self-determination with a further marketisation and commodification of social care. The choice/personalisation agenda makes it difficult, even inappropriate to oppose them, but activists need to understand their dangers, not just for workers who could be increasingly casualised, but also for the population as a whole if services are eroded by people taking the cash option. Also see this commentary from Iain Ferguson who argues that personalisation is window dressing for an assault on welfare.

The new profiteers Allyson Pollock Guardian, October 4, 2007. Lord Darzi's report makes the government's desire for privatisation clear, but this will only lead to more debt and deficit in our hospitals.

Only dogma and corporate capture can explain this. It beggars belief that US health privateers straight out of Michael Moore's Sicko are being lined up to run core NHS services Seumas Milne Thursday October 18, 2007 The Guardian
Scotland - an end to partnerships with the pirate sector. - from Tribune
New SNP health secretary Nicola Sturgeon has signalled an end to future partnerships between the National Health Service and the private sector. She proclaimed that market forces would not lead to better healthcare and that the public opposed “creeping privatisation”. No more taxpayers’ money would be invested in private surgery units and hospitals but would be used to increase NHS capacity.

A global context (from DHRSA): "These notes offer a wide contextualisation of the policies being pursued in the UK and world-wide, as they impact on public services, work, family and communities. ....."

A Typology of Privatisation and Marketisation Dexter Whitfield European Services Strategy Unit.

New Labour's Attack on Public Services - a short book by Dexter Whitfield Modernisation by Marketisation? How the commissioning, choice, competition and contestability agenda threatens public services and the welfare state. This is an excellent overview, particularly relevvant to the creeping privatisation of the current regime.. Introduction. Flyer £buy

The Blair No 10 policy unit's discussion paper on public service reform - our critical comments (in the form of comments written on the original document - we gave it a very generous 4/10) (pdf file - large 3+mB). The original paper (Jan 2007) is at this link, and a final strategy paper has now appeared (March 2007) - useful to know what's coming! This powerpoint presentation from the same stable is also worth a look - note the strategy for introducing these 'reforms' on page 35. The model consists of a four way squeeze on public services through top down regulation, bottom up consumerism, sideways entry of competition and changes to the skills and composition of the workforce - democracy, voice, citizenship doesn't get a mention of course.

Paying the Cost: Public Private Partnerships and the public service workforce. By Sanjiv Sachdev A Catalyst Working Paper. Published: June 2004 Summary Full report download

The future of public services in Europe By Catherine Needham and Alasdair Murray Prepared by Catalyst and the Centre for European Reform for UNISON and Ver.di Published: May 2005 Summary Full report download

The real meaning of public sector reform is privatisation and waste Amicus press release and Glossary of privatisation terms

Chossudovsky, M. (2004) The Globalization of Poverty and the New World Order (Second ed.). Ottawa: Global Research. More info

Public Services and the Private Sector: A response to the IPPR A Catalyst working paper. By Allyson Pollock, Jean Shaoul, David Rowland and Stewart Player. Summary Full download

Halimi, S. (2004, June 2004). Road map for privatisation: The great leap backwards. Le Monde diplomatique - English edition

Useful site on GATS: the General Agreement on Trade in Services, an international trade agreement that came into

effect in 1995 and operates under the umbrella of the World Trade Organization (WTO). The aim of the GATS is to gradually remove all barriers to trade in services. The agreement covers services as diverse as banking, education, healthcare, rubbish collection, tourism or transport. The idea is to open up these services to international competition, allowing the way for huge, for-profit, multinational firms.

How the World Trade Organisation is shaping domestic policies in health care By David Price, Allyson M. Pollock, and Jean Shaoul, The Lancet, Vol. 354, no. 9193, 27 November 1999 (Abstract - NHS and social care colleagues should be able to get the ProQuest full text copy via their Athens registration register from an NHS computer or via your local NHS librarian).

Africa’s medical deficit By Karl Blanchet and Regina Keith The African continent is facing 25% of the world’s morbidity rate with only 3% of its healthcare personnel. This is the result of years of neglect and underinvestment by African governments and the international community, plus harsh IMF restraints on nations’ budgetary expenditures. Le Monde diplomatique - English edition    Dec. 2006

The People's Health Movement: The global ‘Right to Health and Health Care Campaign’ produces the Global Health Watch report - below.

Global Health Watch: The Global Health Watch is a call to all health workers to broaden and strengthen the global community of health advocates who are taking action on global ill-health and inequalities, and their underlying political and economic determinants.
Global Health Watch 2005-2006 Executive Summary Full download Campaign agenda

A Lockean Europe? Kees van der Pijl, New Left Review 37, January-February 2006, pp. 9-37 download (£3) also in Spanish.
The article tracks the removal of macro-economic questions from democratic decision-making as central precondition for the EU’s neoliberal turn. One of the underlying reasons for the current relentless neoliberalisation of health policy.

What future for social Europe? A collection of views on the future of social Europe from a left perspective. A useful summary of the issues. From Catalyst.

War on Want's page on Privatisation, Power & Poverty The privatisation of public services in developing countries is hampering the global fight against poverty.

Canada: Ontario Health Coalition Page on privatization

                Canadian Health Coalition: Privatization Archive (extensive resource)

                  National Union Self managed care and individualized funding: not the same thing! paper fo rthe Canadian
                  Labour Congress, Disability Rights Conference 2000. Very relevant to the current UK choice agenda in social care.
                  Makes the important distincttion between self-directed services and their marketisation implementation through
                  individualised budgets.

                What Americanization of health care really means ( Kathy Eisner and Ish Theilheimer in Canadian Dimension)

Malaysia: Coalition Against Health Care Privatisation

USA:          The Massachusetts Model: Health Care Reform for the Insurance Industry By SHARON SMITH (Counterpunch)
                    The market model just keeps getting worse - how new US legislation seeks to guarantee insurance company cash flow.
                    Market-Driven Health Care and Social Control By John Spritzler (demonstrates the pressures to even further marketisation
                    in the USA) Axis of Logic
                To see how an unsocialised system works watch Michael Moore's new film Sicko    Interesting
                    comparisons with Canada, UK France and Cuba. Interview with Democracy Now at this link.
                    We Are Not Free Health Care as a Human Right HELEN REDMOND Counterpunch - The US private system destroys freedom

Germany:   Health Reform: Turning away from the Solidarity Principle by Hans-Ulrich Deppe June 2007 from INTERNATIONAL
                    ASSOCIATION OF HEALTH POLICY

Understanding Public Services and Care Markets - not particularly critical, but a useful review of the working of the social care market in London - Ann Netten et al. (Kings Fund working paper)

NHS Market Futures Exploring the impact of health service market reforms - has a useful summary of the NHS market reforms to date (pp2-3) (Kings Fund working paper)

Britain: Government fails to tackle MRSA (a likely consequence of privatised hospital cleaning and tight margins of occupancy) 21st Century Socialism 13 Jan 2007

An overview of child well-being in rich countries UNICEF Report Febuary 2007 Alternative download
The UK is bottom of the league of 21 economically advanced countries according to a "report card"' put together by Unicef on the wellbeing of children and adolescents, trailing the United States which comes second to last.

Proportionate Tax Take from Gross Household Income - The Rich Pay Less. By David Byrne and Sally Ruane Relevant to the argument that the NHS as it stands (and other public services) can't be afforded. from Compass.

Give me less choice Sue Blackmore, The Guardian, 2/6/2006

Which Choice? Interesting analysis (and critique) of choice in public policy from the Consumers' Association. March 2005.

Health Policy Debate "This blog provides independent analysis of health policy. It draws on a range of perspectives on British health and health care and exists to help make sense of policy debate." Not very radical but a useful source.

Defending Health and Social Care: Rediscovering the Socialist Alternative - www.dhrsa.org.uk

Evidence

Evidence is a political tool - useful only in conjunction with other campaigning tools. The contestable nature of evidence can be seen in some of the following citations.

Compendium of research on markets & PFI/PPP from Centre for International Public Health Policy, University of Edinburgh

The privatisation of the National Health Service in the UK Colin Leys University of Edinburgh University of Edinburgh May 2007
On the performance of Independent Sector Treatment Centres (ISTCs)

Independent sector treatment centres: evidence so far
A Pollock and S Godden BMJ 2008;336:421-424 (23 February)
Using NHS funds to deliver NHS clinical services via the private sector lacks evidence and has not been evaluated
Data to support government claims that independent sector treatment centres offer high productivity, high quality health care, or value for money are lacking. Such centres are meant to provide extra capacity and staff, but 23 000 NHS beds in England have closed and many NHS clinical staff have transferred to the private sector since their introduction. Patients’, lawyers’, and professional bodies’ concerns over quality and safety are being ignored by government

The Case for Hospital Reconfiguration – NOT PROVEN: A Response to the IPPR’s The Future Hospital by David Byrne and Sally Ruane. "The Institute for Public Policy Research (IPPR) published a report in January 2007 which purported to present the evidence for hospital reconfiguration – including controversial closures of A&E departments However, the authors have not engaged in a proper systematic review of the evidence and their conclusions and argument are open to challenge. The evidence for hospital reconfiguration is at best inconclusive." from Keep our NHS Public - A very useful case study of the dubious use of research to support the neoliberal agenda of health service "reform".

The Department of Health Research and Development Programme (SDO Programme) commissioned a review:
Patient Choice and the Organisation and Delivery of Health Services. The results are largely inconvenient to the policy of increasing choice They have not been widely reported and it is interesting that the summary published Nov 2006 was withdrawn for 'reformatting', reappearing in Feb 2007 with a rather more postive (for the privateers) spin.
Highlights from the report (our selection)
The full report Fotaki, M. et al. (2005). National Co-ordinating Centre for NHS Service Delivery and Organisation R&D (NCCSDO)

Health Commission - Choice of hospital ranked bottom of 82 issues in Health Commission Survey May 2007: The Healthcare Commission said its survey of 80,000 patients was a "vote of confidence" in state care. Health Secretary Patricia Hewitt said: "Staff should take great pride from this endorsement of the care they provide day in day out." Yes indeed.

Impact of competition in the UK on hospital death rates.
Does competition between hospitals improve the quality of care? Hospital death rates and the NHS internal market.
Carol Propper, Simon Burgess and Katherine Green
This study indicates a 1% increase in death rates as a result of competition between hospitals (when other factors are controlled). The neoliberal think tanks haven't been quoting this one! Link to abstract (or full article if you have the right Athens access).

Extending Choice In English Health Care: The implications of the economic evidence Propper, C., Wilson, D., & Burgess, S. (2005). University of Bristol, Centre for Market and Public Organisation. The paper concludes that there is neither strong theoretical nor empirical support for competition, but that there are cases where competition has improved outcomes (but see the above article by the same team for a case where it didn't).

Contract and Privatisation Failures from European Services Strategy Unit
- also see their Modernising Social Services Report into the implementation of modernisation of social services, with evidence drawn from a major survey of social workers in a large case study authority.

WHAT WORKS: PUBLIC SERVICES PUBLICLY PROVIDED By Colin Leys (from the SHA site)

Healthcare lessons from Australia. Jane Hall and Alan Maynard BMJ Feb 2005
The Australian government engineered a major expansion of private health insurance that has increased from 30% to 45% of the population. The strategy of subsidising insurance premiums has been expensive and primarily benefited the wealthy and iInflation of premiums has been high increasing the cost of public subsidies. Meanwhile pressure on public hospitals has not decreased.

The high costs of for-profit care David Himmelstein, and Steffie Woolhandler, in the Canadian Medical Association Journal 8-06-2004; 170 (12)

Not for profits, government control and public accountability: Lessons for policy makers Allyson Pollock, Centre for International Public Health Policy, University of Edinburgh (conference paper - Dept of Health SDO Research Programme) - looks at the supposed virtues of not-for profit or 'third sector' organisations - these are being promoted as a way of making more palatable the privatisation programme, but what is the reality?)..

Defending Health and Social Care: Rediscovering the Socialist Alternative - www.dhrsa.org.uk

So what's the alternative?

WIth the need to struggle against the neoliberalisation of health and other public services, the proposal of alternatives is less well developed: an area in need of sustained work. The texts cited above are good places to start, especially the Hart book. Here are some other resources. Both KONP and the SHA are launching initiatives to develop such positive policy formulation.

What would a new White Paper for the NHS today look like? Allyson Pollock (extracted from KONP overview of "60 years on...")

A New Political Economy Edited by Martin McIvor and Hetan Shah from Compass.
"This report sets out, for the first time, a comprehensive route map for the centre-left to manage the forces of global capitalism in the interests of society. " Useful. Also see their The Good Society.

Towards a New Politics of Health . Politics of Health Group Discussion Paper no. 1 June 2003 Download

Cuba
The Cuban Health care system with its primary care based social model and preventative approach is well known. Here are some sources about it. Cuba’s achievements in health are all the more impressive because they are delivered despite the effects of a 46-year-old economic blockade, illegally imposed by the USA, with the craven complicity of the UK and EU.
First world results on a third world budget - The Guardian, September 12, 2007
See two responses that contextualise this article in terms of the blockade (Rob Miller) and the privatisation of the UK National Health Service (London Metropolitan University).
Spiegel and Yassi Lessons from the margins of globalization: appreciating the Cuban health paradox Journal of Public Health Policy, 2004 - A good overview of the Cuban health system and the lessons we need to learn int hte underpriveliged IMF member states.
Michael Moore's new film Sicko has some interesting comparisons of health service systems in the USA Canada, UK, France and Cuba - Moore interview with Democracy Now at this link. Review of Sicko (21st Century Socialism).
Health Care in Cuba: From Revolution to Evolution - Patrick Pietroni, International Institute for the Study of Cuba., London.

Cuba: Social Policy at the Crossroads Oxfam Research Paper November 2002 Read the full report (PDF, 1.5MB) Spanish version.
Abstract
Cuban Health system FAQ
See also the chapter by Felix Sansó Soberats in the K Sen book., the section in the J. Lister book and the out of print Hippocrates in Havana by Theodore MacDonald (see review). As Lister points out, the Cuban health system, despite the US blockade has not had to implement a single one of the neoliberal measures adopted to varying degrees by all other health systems (actually there is some payment for medicines, dental materials). Its emphasis on public health and primary care, while also developing world class medical technology (see Ernesto Mario Bravo's Development Within Underdevelopment), makes it a model to learn from. Cuba's health indicators rival (and sometimes exceed) those of Western Europe: for comparative data on infant mortality rates see the spreadsheet at http://www.cubasol-manch.org.uk/#infmort Also see: Cuba’s Cure: Why is Cuba Exporting Its Health Care Miracle To The World’s Poor?

Cuba and the polyclinic debate
The idea of the polyclinic - this briefing contextualises Cuba's polyclinics in the Cuba primary care led system - reading for Ara Darzi.
Birth of the polyclinic? (Guardian 11/07/07) - Ara Darzi, the new health minister is proposing the development of polylinics as an intermediate step between hospitals and primary care : of course this model works well in Cuba (where it was established in 1964) although without the added burden of PFI to build them!. See this comment (BMJ) on the differences between the Cuban model and the Darzi ('neoliberal Semashko') proposals. A key point is that alone the polyclinic model was insufficient to allow a community based, preventative, person-centred practice to fully develop: as a result from 1984 Cuba developed its neighbourhood-based family doctor model.

A delegation of over 200 senior doctors including Department of Health officials went to Cuba in 2000. This culminated in a ministerial visit from Cuba to the Department of Health. Political pressure ensured that the developing exchange was curtailed and the UK continued with its flawed health reform. - more-> See also Memorandum by Professor Patrick Pietroni: CUBAN HEALTH CARE SYSTEMS AND ITS IMPLICATIONS FOR THE NHS PLAN (House of Commons Select Committee on Health, 2001.

Scandinavia
Sweden's new social democratic model by Robert Taylor This is from the centre-left think tank - Compass. Interesting (although a bit short on real content) it argues that Sweden has broadly resisted the neoliberal policy onslaught, protecting the Scandinavian welfare state model (i.e. a properly funded and democratically managed one), despite pressure from the EU'. Also see the European Observatory on Health Systems and Policies summary of the Swedish system and other EU country summaries.

Pieces from the UK on alternatives to marketisation
Our alternative to Blair’'s NHS marketplace: Julian Tudor Hart and Alex Scott-Samuel Very brief piece outlining alternative reforms to the NHS. (from KONP)

Machines, markets and morals: the new politics of a democratic NHS - by Neal Lawson. Reviews the democratic deficit in the NHS and comes up with a not very convincing prescription. - from Compass.

A couple of sources on integrated provision and commissioning: - the penny is beginning to drop in some quarters that the shop counter is a bad model for improving health care. See this Jan 2008 statement from the NHS alliance (a bit muddled since it retains the idea of practice based commisioning) and this late 2007 review by Chris Ham (Nuffield Trust) - useful in places in drawing together some counter-current evidence from the USA.

Struggles

Reinstate Karen Reissman campaign by UNISON workers in Manchester

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