Argumentum E-ISSN: 2176-9575 [email protected] Universidade Federal do Espírito Santo Brasil BYWATERS, Paul British social policy: the case of health policy Argumentum, vol. 3, núm. 2, julio-diciembre, 2011, pp. 190-210 Universidade Federal do Espírito Santo Vitória, Brasil Available in: http://www.redalyc.org/articulo.oa?id=475547533012 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative Paul Bywaters ARTIGO British social policy: the case of health policy1 A política social britânica: o caso da política de saúde Paul BYWATERS2 Abstract: This paper is about the targeting of the UK health service by private international health care corporations who want to get their hands on the £200b annual budget and the collusion in that project by successive governments, including the present administration led by David Cameron which is the most ideologically driven government that we have had in the UK in my lifetime – more radical in their dismantling of our welfare state than Margaret Thatcher in the 1980s but building upon her legacy. It is a tale about neo-liberalism, about the power of global business interests, about privatisation, about reducing the role of the state, and about a weak democracy. And so it is a cautionary tale about progress – even when affordable universal health care has been secured, it is not immune from attack and from being reversed. Keywords: Health policy. UK. Social policy. RESUMO: Este trabalho aborda as medidas direcionadas ao serviço de saúde do Reino Unido por empresas internacionais de saúde, que querem colocar as mãos no orçamento anual de £200 bilhões e na conspiração desse projeto que vem de sucessivos governos. Isso inclui a atual administração de David Cameron, que é o governo mais ideologicamente impulsionado que tivemos em toda minha vida — mais radical em desmantelar nosso estado de bem-estar social que Margaret Thatcher na década de 1980, mas que é baseado no legado desta última. Trata-se de um texto sobre o neoliberalismo; sobre o poder dos interesses empresariais globais; sobre a privatização; sobre a redução do papel do Estado e sobre uma democracia fraca. Trata-se também de uma advertência sobre o progresso — mesmo quando cuidados de saúde universais e acessíveis são garantidos, eles não são imunes à reversão. Palavras-chave: Política de Saúde. Reino Unido. Política Social. Submetido: 21/7/2011 Aceito: 2/9/2011 1 Partes dessas reflexões foram apresentadas no 6° Encontro Nacional de Política Social em Vitória (ES) entre os dias 28 e 30 de setembro de 2011. 2 Emeritus Professor of Social Work, Coventry University, and Honorary Professor, University of Warwick (UK) E-mail: <[email protected]>. 190 Argumentum, Vitória (ES), v. 3, n.2,p. 190-210, jul./dez. 2011 British social policy: the case of health policy Introduction the world is trying to move towards universal health coverage, in England our government is pushing through he WHO World Health Report policy changes which will end universal for 2010, published last equality of access, increase costs and December, was entitled ‘Health reduce the quality of our health care Systems Financing: The Path to system. How can this be? Universal Coverage’. T So this paper is about the targeting of the It acknowledged what the Commission UK health service by private on the Social Determinants of Health international health care corporations had said in 2008, that the circumstances who want to get their hands on the in which people grow, live, work, and £200b annual budget and the collusion in age - education, housing, food and that project by successive governments, employment and the distribution of including the present administration led power in societies - are the most by David Cameron which is the most significant influences on how people live ideologically driven government that we and die. But timely access to health have had in the UK in my lifetime – services a mix of promotion, prevention, more radical in their dismantling of our treatment and rehabilitation – is also welfare state than Margaret Thatcher in critical. the 1980s but building upon her legacy. ‘Recognizing this, Member States of the It is a tale about neo-liberalism, about World Health Organization (WHO) the power of global business interests, committed in 2005 to develop their about privatisation, about reducing the health financing systems so that all role of the state, and about a weak people have access to services and do democracy. And so it is a cautionary tale not suffer financial hardship paying for about progress – even when affordable them.’ (Executive Summary 2010) universal health care has been secured, it is not immune from attack and from But as I started to write this paper in late being reversed. July I received an email. It was a report of a newspaper article in the Daily How does the NHS Work? Telegraph, a leading serious, right wing national newspaper in the UK, under the Let me go back a step or two to explain headline. ‘The day they signed the death to you what has been happening in the warrant for the NHS’ - the English UK. In a sense the English National National Health Service. I suspect that Health Service is the story of my life. The you will have heard much more about birth of the NHS came in 1948, the year President Obama’s struggle to improve before I was born. And the NHS was health coverage in the USA, but there is founded on two key pillars. It gives also a profound fight in the UK to try to everyone access to comprehensive health save our national health service. While 191 Argumentum, Vitória (ES), v. 3, n.2,p. 190-210, jul./dez. 2011 Paul Bywaters care that is ‘free at the point of delivery’ an expert in the aspect of medicine that – when you go to see a doctor or a nurse is relevant. or go to hospital you do not have to pay You cannot usually go directly to a anything. And the second pillar is that hospital to see a specialist doctor unless health care is paid for out of general you have an accident or are suddenly taxation. The UK does not have an taken seriously ill. In that case you can insurance based scheme, we pay our go directly to an Accident and national taxes, and some of the money is Emergency Department in a hospital and used to pay for the NHS. And with tiny get emergency treatment. exceptions, there are no co-payments. All of this is free – no money changes When a doctor recommends that you hands between you as a patient and any take medicine or drugs you have to pay of these services and effectively the a prescription charge but this is less than doctors prescribing treatment have no £10 per go and many groups – personal interest in the cost of the pensioners, the unemployed, pregnant treatments they prescribe – they cannot women – are exempt. make more money be prescribing one form of treatment, one drug rather than At the moment, the English health another, although there are some general service works like this from the patients’ controls on this to prevent waste. And so perspective. Virtually everyone is patients can trust their doctors not to be registered with a small group of primary acting out of personal gain. care doctors, what we call General Practitioners, GPs. If you are feeling ill, There is a relatively small market in or need a vaccination or other preventive private health insurance in the UK which treatment, you simply make an is complementary to the state provision, appointment with your GP and usually buying faster access to specialist care, or see them the same day. GPs are based choice of private care provider. locally – mine is about half a mile away from where I live – and grouped in However, by 2006 only 1% of total health surgeries or clinics, usually half a dozen expenditure went on private health or so doctors with some nurses and insurance with only 10% of the other health professionals and population having some complementary administrative staff. Numerically, the private health insurance (Thomson and vast majority of health concerns for Mossialos 2009). And a larger group of which the health service is consulted are people will sometimes use private health dealt with by GPs. Some investigations – care services, paying for the care blood tests, for example – will also be themselves without insurance. done through the GP. But if you need more specialist care the GP will refer you By contrast social care – care services for to an NHS hospital where you will see adults who are disabled or with learning disabilities, and care services for older 192 Argumentum, Vitória (ES), v. 3, n.2,p. 190-210, jul./dez. 2011 British social policy: the case of health policy people who are no longer able to look developed countries. It was particularly after themselves without help because effective at making access to health care they are frail or suffering from dementia, independent of how wealthy you are for example – including services (Schoen et al 2010). As Table 1 shows, provided through social workers, are this is reflected in exceptionally high mostly not free in England and are run levels of adult confidence in the NHS. in through a completely different system The UK was the only country in which to the NHS. These services are heavily more than 90% of the adults surveyed rationed in two main ways: first you said that they were conifdent that if they have to be assessed as sufficiently in were seriously ill they would receive the need to be eligible for a service, and most effective health care including secondly, any services that are provided drugs and diagnostic tests and that they through the state are means tested.