Looking backwards to the future

Feasible Socialism: The national Health Service past, present and future
Julian Tudor Hart
Socialist Health Association, 1994

As has often been noted before in the pages of healthmatters, there is a symbolic quality about the National Health Service which seems to inspire a degree of affection and loyalty on the part of the public far greater than that for any other state-owned service. For the left in particular, and perhaps also for the right, this seems to translate readily into the idea that the NHS offers us a glimpse of a socialist future. It is an appealing idea and, based on the present reality of a service which often strives to respond to need rather than social status or wealth, it deserves critical attention.

The NHS-as-the-future is the central theme which runs through this slim volume from the Socialist Health Association. Its author, Julian Tudor Hart, should need little introduction as the respected (and now retired) South Wales GP and socialist commentator on matters of health service policy. Here, Tudor-Hart presents a wide-ranging discussion of health service policy and politics, from the origins of the NHS to its future as a ‘socialised’ health service, with particular attention to the 1991 reforms and the current semi-privatised results.

Unfortunately, the text has breadth at the expense of depth, and a critical analysis of the status quo together with a set of coherent and strongly argued policy directions for a future Labour government are largely absent. As so often the case on the left, Tudor Hart’s view of the past is a little misty-eyed and he is unable to come to a clear judgement on the merits of the pre-Thatcher NHS. Was the NHS of the 1960s and 1970s over-managed or under-managed? Did it provide services on the basis of need? Was it really responsive to community and user demands?

Again, the critique of the present and, in particular, the purchaser-provider split, is rudimentary. While Tudor Hart is critical of the Labour Party for being ‘unclear’ on the split in Health 2000, his own discussion is so inconclusive as to make it impossible to judge whether or not he supports this key feature of the 1991 reforms.

Rightly, there is a strong emphasis here on professional and managerial accountability, yet the lack of critical reflection on what is required means we are left with little idea of how the rhetoric of accountability could be turned into reality. The political tensions buried within the term - of professional versus state control, of the needs of the patient versus the needs of the wider community - are left unexplored.

Perhaps it is unfair to judge the book in these terms, since its ambitions may be more towards polemic than analysis. But effective polemic must aim to win minds as well as hearts.

James Munro