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Contemporary Health Issues. Week 8 Social determinants of health: the policy response. CHI Week 8. Lecture will cover: Health policy before New Labour New Labour and health policy Issues in assessing New Labour. Health policy before New Labour.

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contemporary health issues

Contemporary Health Issues

Week 8

Social determinants of health: the policy response

chi week 8
CHI Week 8

Lecture will cover:

  • Health policy before New Labour
  • New Labour and health policy
  • Issues in assessing New Labour
health policy before new labour
Health policy before New Labour

Thatcher/Major governments’ health policies for the NHS were characterised by:

  • Internal market
  • Drive for ‘efficiency’
  • Centrality of ‘choice’ for patients
  • Decentralization
health policy before new labour1
Health policy before New Labour

Cornerstone of Conservative policy:

  • Separation of providers and purchasers
    • Hospitals provided services to ‘purchasers’
    • Purchasers were fundholding GPs and Health authorities.
health policy before new labour2
Health policy before New Labour
  • Clinical effectiveness
    • Concern among some groups with the NHS that clinical effectiveness was lost in the new reforms
    • Market approach may not take enough account of clinical needs/concerns
new labour s green paper 1998 our healthier nation
New Labour’s Green Paper 1998‘Our Healthier Nation’
  • Government acknowledges impact of health inequalities for first time since 1980 Black Report
  • Key goals of ‘improving the health of the worst off in society and closing the health gap’.
  • Advocates ‘third way’…Good health is no longer about blame, but about opportunity and responsibility
  • Will seek to do this through ‘partnership between government, local communities and individuals’
new labour and health policy
New Labour and health policy
  • Stay within Conservative spending plans for first three years of government (pre-1997 election pledge)
  • End to yearly contracting by health authorities - 3 yearly agreements with trusts
  • GP fundholding absorbed into Primary Care Trusts (PCTs)
new labour and health policy1
New Labour and health policy
  • ‘Primary Care Trusts (PCTs) will continue to have the key role in representing the NHS in local strategic planning arrangements around health improvement and inequalities, and the development of partnerships with key local agencies…’ (Feb 2003)
  • PCTs, then, are a local governing body made up of GPs, lay people, nurses, social service reps, public health reps.
new labour and health policy2
New Labour and health policy

Policy aims of central government:

‘Focusing on improving services and outcomes in: cancer coronary heart disease mental health older peopleimproving life chances for childrenreducing health inequalities’

Priorities and Planning Framework 2003- 2006 (NHS Plan)

new labour and health policy3
New Labour and health policy
  • Continuing the controversial Private Finance Initiative (PFI)
  • Foundation Hospitals
    • Individual hospitals can set staff wages
    • Can attract private finance
    • Hospitals run by Boards which have to have members from the local community
  • July 03 – Foundation Hospitals Bill passed in Commons by 35 votes; 6 Nov – rejected by Lords;Bill returns to Commons for second vote today!
new labour s social exclusion policies
New Labour’s social exclusion policies
  • End Child Poverty in 20 Years
    • Interim target of 1 million children out of poverty by 2004/05
    • Since 96/97 500,000 children no longer living in poverty (down from 4.3 million to 3.8 million)
  • Promote social inclusion especially through welfare to work and neighbourhood renewal
social exclusion and health
Social exclusion and health
  • National Childcare Strategy (NCS) launched in 1997 – targets disadvantaged wards:
    • Sure Start: incorporates family health issues
  • Health Action Zones
    • ‘Building capacity’ in local communities
    • Profile local health problems and decide how to deal with them
    • Multi-disciplinary teams
assessing new labour
Assessing New Labour
  • Tackling inequalities or placing onus on individuals and communities?
  • Empowerment or social control of the poor through ‘social inclusion’ and ‘community development/building capacity’?
  • Continued social exclusion of some groups, eg: asylum seekers?
assessing new labour1
Assessing New Labour
  • If health inequalities are related to the RELATIVE wealth gap, should New Labour do something about income re-disribution?
  • To what extent are New Labour’s social exclusion policies dealing with health inequalities?