Review

Left behind by the right

SOCIALISM AND THE NHS: FABIAN ESSAYS IN HEALTH CARE
ed John Carrier & Ian Kendall
Avebury, 1990

This small serious book of essays by distinguished and knowledgeable academics has a Brezhnevite tone, spiced with Gorbachovian heresies, that truly fits a discussion about ‘socialism and the NHS’. The introduction notes the lack of self-congratulation on the 40th anniversary of the NHS, but the essays do not spell out the reasons for the health service’s plight. The commentaries note the challenge of the market, but readers wanting succinct and comprehensive assessments of market mechanisms in health care will have to look elsewhere. Predictably, the analysis is already outdated, being derived from seminars in 1986 and 1987, updated in response to the white paper Working for Patients.

Sadly, Socialism and the NHS was probably out of date the day it appeared, such is the rate of change in the health service. Had the Fabian Society produced a pamphlet using state-of-the-art technology, they might have made a timely contribution to political debate. Choosing not to seems typical of that stubborn socialist resistance to rapid response and imaginative action which has made so many despair of the left.

Perhaps the essays would have made more impact on me if they had not been quite so Olympian, but that would be asking the Fabian Society to be something it is not. These are social policy essays for social policy people to read. Those wanting a whiff of the sweat and cordite wafting round the NHS at the moment will not find it by looking down on the political battle from a great height.

They will find interesting facts and arguments, a very impressive review of the relationship between the NHS (or rather, medicine) and the pharmaceutical companies by Joe Collier, and effort by Judith Allsop to describe the mixed economy of health care which is evolving faster than we can grasp, and outlines of policies for community care, older people and ethnic minorities.

Missing is any explanation of how improved health among the salariat and skilled working class has altered their demands on health services, so creating a new agenda for health politics. Neither do the authors (with the exception of Judith Allsop) re-evaluate the top-down, command structure of the NHS as one particular historical form of health service, and not the best of all possible worlds. In one way these gaps in socialist thinking make for interesting, if ominous reading today. They remind me of General Jaruselksi and the East German leader Egon Krenz, who also knew that change was unavoidable but could not quite see how to steer through it.