Abstract
The report of the Royal Commission on the NHS (1979) arguably represented not only an overwhelming endorsement of the service, but also the high-water mark of a particular style of policy making. The searching inquiry of the Royal Commission, backed up by substantial academic research, aimed to reach a degree of consensus from which the Conservative government elected in 1979 and its successors have subsequently departed quite dramatically. The contrast between the slow and extensive deliberations of the Royal Commission, appointed by the then Labour government in 1976 and reporting in mid-1979, and the extremely rapid production of the 1989 White Paper, described by its progenitors as the most fundamental innovation in the NHS in 40 years, is instructive. The Royal Commission received 2460 submissions of written evidence and held 58 sessions at which oral evidence was given; 2800 individuals were also spoken to in the course of its deliberations, the subcommittees of the Commission held 83 meetings, and six major pieces of academic research were commissioned and their results published. The sheer volume of evidence submitted and considered contrasts sharply with the peremptory production of the NHS review, announced via the novel medium of a television interview and assembled via the secretive deliberations of a team heavily dominated by Treasury ministers.
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Notes and References
In other words, levels of efficiency savings were not specified from the centre, but were agreed between regional and local tiers of the service. However, while centrally specified target levels of efficiency were no longer prescribed, the government’s underfunding of pay awards had much the same effect. The government rarely accepted in full the recommendations of the Review Bodies for doctors, dentists and nurses; even when they had decided on the awards to be offered, they did not fund them fully, regarding this as a stimulus to efficiency on the part of health authorities.
The Observer (20 March 1994) reported the possibility of patients paying the full price for NHS dentistry, although it was also reported that a quid pro quo would be the reintroduction of free dental and optical checkups.
DoH / OPCS Annual Report, 1992, Cm. 1913, table 4. One of the reasons for the increase is the rapid rise in income from paybeds in NHS hospitals, which has followed from legislation that permitted health authorities to set paybed charges at commercial rates. This does not include capital receipts; at one point during the 1980s these accounted for some 20 per cent of NHS capital expenditure, though that figure has dropped sharply as property prices have fallen.
Health and Personal Social Services (HPSS) Statistics, 1991 and 1992, table 2.1.
Quoted in Social Services Committee, 1988a, para 14.
Treasury and Civil Service Committee, 1988, Evidence, Q 145.
Evidence to Health Committee, 1991c.
Social Services Committee, 1988a, para. 12.
Mr I. Todd, president of the Royal College of Surgeons, and Sir R. Hoffenberg, president of the Royal College of Physicians, in evidence to Social Services Committee, 1988a, Q3 and 4.
Sir George Godber (former Chief Medical Officer), letter to the Lancet, 12 December 1987.
HC Deb., 15 December 1988, v. 124, c. 918-921
DoH/OPCS (1992), Annual Report (Cm. 1913), figure 18. This indicated that CRES were to increase by £280 mn between 1990–1 and 1991–2.
DoH Statistical Bulletin 1993/2, NHS Hospital Activity Statistics, England, 1981 — 1991–2.
Data on temporary closures are not collected centrally because these closures do not require ministerial consent. The reports produced by local campaigning groups, especially in London, give some idea of the extent of temporary or partial closures of services. London Health Emergency (1986, 1987a, 1988) document the extent of the problems suffered by DHAs in the capital, with virtually every DHA, in the 1987–8 financial year, having to take decisions to close, on a temporary basis, at least some beds or wards. On the question of new or replacement facilities, information is given on a regular basis in Social Services Committee reports about capital schemes approved in principle, but there is no summary of the number of beds that are provided as a result of such schemes.
Social Services Committee, 1988a, Vol. II, Evidence, Q408, and, more generally, Q408-432 on bed closures and the monitoring thereof.
Thus the number of non-psychiatric hospitals has fallen dramatically — in England, from 1609 in 1979 to 1147 in 1991. The greater part of this reduction was due to a fall in the number of hospitals with less than 250 beds from 1306 to 884; the mean size of hospitals rose from 151 beds in 1979 to 168 beds in 1990–1. Source: HPSS Statistics, 1991, table 4.2.
In psychiatric services for the 1979–91 period, the reduction in beds from 127497 to 62906 is largely due to community care initiatives. Large institutions have been substantially eliminated: while there were 31 psychiatric hospitals with over 1000 beds in 1979 there was one in 1991; 29 hospitals have over 500 beds, compared with 106; nearly half have under 50 beds compared with one third. Source: HPSS Statistics, 1993.
HPSS Statistics, 1993, table 5.12.
HPSS Statistics, 1991, table 4.3.
HPSS Statistics, 1992, table 4.5.
DoH Statistical Bulletin 1993/2, NHS Hospital Activity Statistics, England, 1981 — 1991–2; HPSS Statistics, 1993, table 5.12.
‘NHS Waiting lists reach record highé, Guardian, 7 May 1994, p. 8. These figures only include individuals actually on waiting lists for treatment; they do not include those waiting for outpatient appointments prior to joining official waiting lists.
These years were chosen because in 1981 a reduction in the working week for nurses from 40 to 37.5 hours had the effect of increasing the WTE figure for nursing staff by approximately 31 000.
For example the 1987 Public Expenditure White Paper ((Cm. 56), vol. II, p. 225), commented that the ‘number of staff providing direct patient care has increased both absolutely and as a proportion of total staff’. Subsequent white papers continued to stress this.
HPSS Statistics, 1993, table 7.1.
Health Committee, 1991c, Evidence, Q259, Q274; see also Health Committee, 1991d.
HSJ, vol. 104 no. 5393, (10 March 1994), pp. 32-33, ‘Evaluating the Reforms’. The Department of Health published, early in 1992, a document that argued that, even at that early stage of the reforms, there were significant improvements in care and responsiveness to individuals, and better value for money. However a critical analysis of that publication (Radical Statistics Health Group, 1992) showed how the Department of Health had failed to compare changes with longer-term trends, and had not allowed for changes in age structure and data-collection systems.
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© 1995 John Mohan
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Mohan, J. (1995). From the Royal Commission to the NHS Reforms: A Review of Policies and Statistics. In: A National Health Service?. Palgrave, London. https://doi.org/10.1007/978-1-349-23897-2_1
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