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: 23 July 2008
Site menu
Defending Health and Social Care: Rediscovering the Socialist Alternative - www.dhrsa.org.uk
Social Care Consultation - another dose of neoliberalism?
Department
of Health launches consultation on the future (funding) of social care.
This is potentially very significant and could herald a move to a
social insurance model - a further retreat from the universalism that
undrepins / undderpinned the NHS.
Government announcement and consultation site
Summary from the NHS Confederation
(not recommended for their suggestions - shared costs between
the State and individuals who would therefore top up a minimum
entitlement, possibly from insurance - but it is a handy demonstration
of some of dominant ideas.
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.
Defending Health and Social
Care: Rediscovering the Socialist Alternative - www.dhrsa.org.uk
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
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 relevant to the creeping
privatisation of the current regime.. Introduction.
Flyer
£buy
read review
Other
sources
Our NHS: privatisation by stealth
Gail
Cartmail, 21st Century Socialism: November
17th 2006
Totem of the people by Hilary Keenan 21st Century Socialism July 5th 2008
The
data cited (OHE via Pollock) on the superior efficiency of the NHS are
interesting - for example the following graph shows how the NHS gets
more reduction in infant mortality per pound (per capita) of GDP than
other OECD systems - particularly the US one. Look at
the increasing crisis of the US system. The full calculation can
be found in
this spreadsheet together with some related
graphs. Of course this is a gross analysis, there are other
factors such as the impact of increasing inequality, but it does
give the lie to neoliberal claims that the NHS is particualrly
inefficient.
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
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:
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."
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.
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
Spain: Announcement of formation of Coordination Group of Public Health Service Workers against Privatisation in Madrid.
From Insurgente - in Spanish.
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.
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
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
contact us:
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