Review

Dissecting ‘the hidden hand’

Social policy for nurses and the caring professions
Louise Ackers and Pamela Abbott
Open University Press, 1996, £12.99

Not only have Louise Ackers and Pamela Abbott provided a thorough overview of the history of social policy, but they have managed to provide a damning critique of recent government policies without becoming polemical.

Healthcare is used as a case study on a number of occasions, and in their analysis the authors show evidence of a wide knowledge of other social sciences. This books shows how the disciplines — social policy, sociology, economics and politics — often overlap; for example, the sociological critiques concerning inequalities in health and healthcare combine elements of all the other three.

The authors remind us that recent governments have ostensibly introduced policies of the ‘classical liberal’ ideology of the New Right: a pursuit of greater efficiency by pushing back the frontiers of the State and ensuring that individuals are responsible for their own welfare provision, dependent on the ‘invisible hand’ of Adam Smith’s market, and thus reducing bureaucracy and taxation.

But the real results have been a ‘marked centralisation of power and resources at the expense of local autonomy’. There have been other critics of recent policy, e.g. the Right-wing think-tank, the Adam Smith Institute. It criticises increases in NHS administrative and management costs, believing that Conservative administrations have failed to go far enough in introducing a market economy to healthcare.

A contradiction not analysed by the authors is that the market has never provided healthcare for the poor, because poor people have too few resources to be active participants in the market. Consequently, pre-NHS, often the only access to healthcare was through charity, with many having no access at all. If the State does not provide for welfare and healthcare, then the market would not freely supply a service to the poor.

The authors conclude by reminding us that bureaucracy has increased since the introduction of reforms, that NHS costs have continued to rise, as has taxation, that power has moved further to the centre, and ‘for the majority, the talk of choice is empty rhetoric’.

The authors do not challenge the politicians to accept the full logic of the market and withdraw the State completely from welfare and health provision, but the total abandonment of the NHS is an unlikely vote-catcher in 1997.

A very good read, which does demand a greater analysis from social scientists, but nevertheless is an excellent introduction to social policy for health professionals, and further reading is encouraged throughout.