Search results

The article examines developments in the marketisation and privatisation of the English National Health Service, primarily since 1997. It explores the use of competition and contracting out in ancillary services and the levering into public services of private finance for capital developments through the Private Finance Initiative. A substantial part of the article examines the repeated restructuring of the health service as a market in clinical services, initially as an internal market but subsequently as a market increasing opened up to private sector involvement. Some of the implications of market processes for NHS staff and for increased privatisation are discussed. The article examines one episode of popular resistance to these developments, namely the movement of opposition to the 2011 health and social care legislative proposals. The article concludes with a discussion of the implications of these system reforms for the founding principles of the NHS and the sustainability of the service. ; El artículo examina la evolución de la mercantilización y la privatización del Sistema Nacional de Sanidad (SNS) en Inglaterra, sobre todo desde 1997. Explora el uso de la competencia y la subcontratación de servicios auxiliares y el uso en los servicios públicos de financiación privada para desarrollos de capital a través de la Iniciativa de Financiación Privado. Una parte sustancial del artículo examina la repetida reestructuración del sistema de sanidad como un mercado de servicios clínicos, inicialmente como un mercado interior sino posteriormente como un mercado creciente apertura a la participación del sector privado. Algunas de las implicaciones de los procesos de mercado para el personal del NHS y de creciente privatización se discuten. El artículo examina un episodio de la resistencia popular a estas tendencias, es decir, el movimiento de oposición a la salud y las propuestas legislativas del SNS en 2011. El artículo concluye con una discusión de las consecuencias de estas reformas fundamentales del sistema nacional de sanidad y la sostenibilidad del servicio.

Any examination of democracy in the health service is troubled by confusion and complexity. In this essay, Dr Sally Ruane of the Centre for Health and the Public Interest writes for Democratic Audit about the recent history of patient and public involvement in the NHS, and those elements of the health system lying outside the NHS. Dr Ruane identifies the barriers to democratic engagement and sets out ways in which accountability can be strengthened, particularly through Healthwatch and local authorities.

The Private Finance Initiative (PFI) allows corporations to access guaranteed flows of public funds in exchange for the use of new facilities and the provision of asset-based services such as maintenance and estates management. The policy has been developed in the UK since 1992 and has been applied in fields of social policy analysis: notably, health and education. PFI has been a difficult policy to make work and since its introduction, governments and businesses have sought to develop strategies to shape both its evolution and its implementation. These strategies have aimed to overcome significant institutional, technical, ideological and practical barriers. Through business—government collaboration in relation to the restructuring of the institutions of the state, the production of a pro-PFI rationale and mechanisms for the spread of technical know-how, businesses have been brought to centre stage in policy making and policy delivery.

IT WAS AUGUST AND THE SILLY SEASON, so it was perhaps not clear at first whether the news from the Cumberland Infirmary, Carlisle, was a spoof or not. Collapsing ceilings? Flooding sewerage? No air conditioning and an indoor temperature of 33 degrees centigrade (thanks to a transparent roof)? A beds crisis in August? Unfortunately, far from spoof, this was the real life experience of a shining flagship development of the Private Finance Initiative— one of the country's first new PFI hospitals (Mathiason, 2000). Thirty-seven others, worth over £3.6bn, have been approved for development so far.

This article uses an examination of the changing boundaries between the public and the private in health-care to argue that developments of a transformative character are taking place in the NHS. Rather than fo cusing on principles such as comprehensiveness and universality, it con siders the collectivism of funding and the production of health-care to be the central features of the NHS in 1948. It is these which are now being eroded. This exploration does not confine itself to policy measures but considers the changing political dynamic within and around the NHS and its changing culture to be significant factors in current and potential change.

El artículo examina la evolución de la mercantilización y la privatización del Sistema Nacional de Sanidad (SNS) en Inglaterra, sobre todo desde 1997. Explora el uso de la competencia y la subcontratación de servicios auxiliares y el uso en los servicios públicos de financiación privada para desarrollos de capital a través de la Iniciativa de Financiación Privado. Una parte sustancial del artículo examina la repetida reestructuración del sistema de sanidad como un mercado de servicios clínicos, inicialmente como un mercado interior sino posteriormente como un mercado creciente apertura a la participación del sector privado. Algunas de las implicaciones de los procesos de mercado para el personal del NHS y de creciente privatización se discuten. El artículo examina un episodio de la resistencia popular a estas tendencias, es decir, el movimiento de oposición a la salud y las propuestas legislativas del SNS en 2011. El artículo concluye con una discusión de las consecuencias de estas reformas fundamentales del sistema nacional de sanidad y la sostenibilidad del servicio.

Amid urgent debates around the function of welfare in the post-industrial 21st Century, and how we pay for it, David Byrne and Sally Ruane deploy the concepts and analytical tools of Marxist political economy to better understand recent developments, and the possibilities they present for social change

Amid urgent debates around the function of welfare in the post-industrial 21st Century, and how we pay for it, David Byrne and Sally Ruane deploy the concepts and analytical tools of Marxist political economy to better understand recent developments, and the possibilities they present for social change.