The NHS has been in the news recently perhaps more than ever. News reports have featured the proposed changes to the service, opposition to the NHS Bill from a variety of corners such as several groups of health care professionals including nurses, some doctors and other political parties. Despite all of the opposition, the demonstrations, the campaigning and the use of the media to report this, the bill is going to become law in a few days time. The implications of this have been long debated; will competition increase efficiency but produce more health inequalities? Is the NHS actually being privatised? Will the large American private companies who have been patiently waiting in the wings carve up the once socialist NHS and ruin it by turning health into a commodity to be bought and sold? Will the NHS become like the American system of health care? The predicted outcomes varying according to which ideological viewpoint is adopted and of course time will certainly tell (see http://www.bbc.co.uk/news/health-17348616 and http://bengoldacre.posterous.com/what-do-doctors-nurses-say-about-the-nhsbill)
Chapter eleven provides a description of health policy and the political environments in which it is created, as well as a discussion of how ideology influences health care. This is all now being played out in real life. The constant change that the NHS has undergone since its inception shows us that health is absolutely political. The NHS has always undergone changes, reforms and ‘improvements’ with political interference at the centre of these processes. Politicians base election campaigns around the NHS, which shows how important it is within the UK context. Apparently we (the general public) are very satisfied with the NHS as shown in survey data but governments always return to the issue of how much it costs and remain focused upon potential future costs. Certainly all health care is rationed in some form or another, and rationing has always operated within the UK too despite the historical socialist underpinnings of our system. The existence of the National Institute for Clinical Excellence and the provision of guidelines about the availability of certain drugs and treatments are demonstrative of the processes of rationing. Individual and media responses to rationing decisions also tell us how value laden these decisions are; campaigns for Herceptin, the drug which can prolong life in late stage breast cancer patients appeared in the past (see http://news.bbc.co.uk/1/hi/health/5058952.stm ) More recently campaigns for the introduction of cervical screening for women younger than 25 have been seen. Debates about the postcode lottery are ongoing; some women can have IVF treatment in one area, but not in others (see http://www.bbc.co.uk/news/uk-england-leicestershire-13660087
There has been some recent media coverage of these issues, reporting how NHS patients being denied care if they smoke, are too fat or even too thin. (see http://www.metro.co.uk/news/892352-patients-denied-care-if-they-fail-nhs-fat-and-fags-test). Pulse Magazine investigated 91 primary care trusts across the UK and produced a report outlining many areas in which treatment is being restricted based upon individual characteristics and behaviours (see http://www.pulsetoday.co.uk/article-content/-/article_display_list/11012068/pulse-in-the-news). The treatments being restricted include fertility procedures, knee and hip operations and weight loss surgery. The Shadow Health Secretary called for government intervention in relation to these ‘discriminatory policies’. He also referred to the NHS saving money by making judgemental decisions based upon the lifestyle that people adopt. However, this is not a new practice, similar media reports and controversy have been evident for years, and documentaries periodically focus upon this issue. The NHS founding principles of comprehensive and universal health care for all, from cradle to grave appear to have been lost along the pathway to modernisation, improvement and the drive to achieve cost effectiveness.
Whilst Contemporary Health Studies as a book conveys the crucial importance of the social determinants of health, the provision of health care is also related to health inequalities. In denying some groups of people treatment, the NHS is creating further inequalities. Indeed, the new NHS bill and associated changes have implications too in terms of inequalities. Whilst health care in high income countries is not a major determinant of population health when compared to the other social determinants, drives for cost effectiveness and value judgements about the ‘wrong’ lifestyle choices are not positive for heath inequalities. Indeed, coupled with the other cuts that are being introduced in relation to welfare and the reduction in public sector services inequality does not appear to be on the political agenda (see http://www.guardian.co.uk/commentisfree/2012/jan/23/welfare-cuts-emergency-loans) . Consideration is also not being afforded to how all of the current changes may serve to increase inequalities further and thus impact upon health negatively. The UK is socially unequal, with an unequivocal evidence base to support this and this remains the large scale political challenge. On a positive note, current changes in NHS provision include the creation of Commissioning Boards and Clinical Commissioning Groups who have been given a remit to tackle health inequalities within the newly structured health service. However, no guidance is available explicitly detailing how health inequalities should be tackled and for many commentators the structural determinants of health remain beyond the remit of health care policy.