The health debate: Policy & Politics in the Twenty-First Century (Policy and Politics in the Twenty-first Century Series) Review

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(More customer reviews)This is an important analysis of the mismanagement of the UK NHS in the last twenty years. The UK NHS is both a good example and a dire warning to the rest of the world. It's a good example in that we achieve population coverage to some level. The dire warning bit is that the standards (of access, and outcomes achieved) are not as high as we like to think, or as good as in comparable European countries.
Imagine a car company that did not like its engineers. That's about the relationship between NHS management and the doctors and nurses who deliver the care to patients. Hunter clearly shows the problems that such an attitude causes and reminds us, ""As any change management text will state, the chances of ensuring that successful implementation occurs are seriously impaired if those working on the front line are not signed up to the changes and seek to contest, or undermine them.....A key feature of the most recent changes in the NHS in England is that the key professions have been disengaged from the reform process"
The UK NHS is a dire warning to others. It has consumed vast amounts of policy ideas and money, and delivered little in return for all the investment spent on it. The processes of change have been disruptive, faddy, and not sustained rather than constructive with long term outcomes in mind. Hunter describes the policies and their botched implementation carefully, and is clear about the consequences. The book is clearly written and well referenced, and so makes a strong case for its conclusions.
The tragedy is that all of us are suffering from this- doctors, patients, managers, voters, taxpayers, politicians.
Read this excellent book to find out where things have gone wrong in the NHS and why. And then make a note that centralized top down schemes which do not engage the workers will never succeed. No matter how much you paid the management consultants and special advisers to write them.
And if Americans are looking for a scheme to emulate then the UK NHS probably is not it.

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