This edition and the ones before it provide first-rate information on the NHS and its ongoing reform. Ham presents a clear introduction to the history of the NHS and how it is funded, and includes updated and comprehensive commentary about health policy formulation in the United Kingdom. The key aim of this sixth edition is to provide ‘a comprehensive and up-to-date introduction to the subject, and a unique outstanding outsider/insider perspective on the issues discussed’.
Ham achieves the first objective through the carrying out of some very careful fine tuning, bringing the reader up to date with health care policy changes: the financing of health care; policy and priorities within the NHS; reforms to the delivery of health care and priority setting. Updating health policy in Britain is quite a feat, as NHS policies and legislation tend to sprawl into various new-found corners within the various realms of healthcare provision. Health Policy in Britain carefully updates the reader with a multiplicity of officially circulated Command paper, Reports, Guidance documents and various other publications.
The book deals not only with the nitty-gritty of policy detail and intent but with institutional structures as well. In fact, it goes deeper than this as it considers carefully the lessons to be learnt from the revolutionary changes initiated by the Conservative governments and the various New Labour policy tweakings that followed. This edition includes an additional chapter about financing health services as well as an overview of what has been achieved in public health since the 1970s. Policy and priorities in the NHS and the process of policy making are examined in Chapter 5. This chapter pays attention to various areas of health care such as cancer, heart disease and strokes, mental health, learning disability, older people, children's services and maternity care. In Chapter 8, the reader is taken through an analytical tour of the health policy community within as well as outside the Department of Health. This brings us to the question: does the book present a uniquely outstanding insider perspective?
Ham weighs up the complexities of British health policies and raises issues such as: why do planned changes result in unplanned consequences? Are some health policies inconsistent or are they merely experimental? Are policymakers capable of managing the variation in momentum between policy and practice? The processes of policy making and prioritising are examined in Chapter 5 as well as Chapter 12. Within his analysis of policy making, Ham offers personal reflections as an insider here, as well as elsewhere in the book. As the Director of the Department of the Health Strategy Unit and drawing also from his experience as ‘researcher and adviser to NHS bodies and national organisations’, he provides insider glimpses sprinkled with humorous metaphors, analogies and observations conveying strongly an impression that his analysis is grounded in practical experience.
Chapter 6 discusses the roles of persons who generate policy from inside and outside government. A chapter dedicated to Westminster and Whitehall may seem like a side tracking exercise, however the chapter demonstrates that an attempt to pin down where power actually lies and who holds it is a very intricate intellectual task. Personality, experience, knowledge, commitment and deep-rooted ideas are the invisible gods capable of creating both harmony and havoc: effective policies as well as policies that are bound to fail. This chapter lays the foundation for Chapter 8, which places the Department of Health (DH) within a broad social, national and political perspective. Within the DH ‘bargaining, negotiation and accommodation between different interests’ are what keeps policy communities ticking over.
This comprehensive review of health services in UK is ideal material for students of health sciences, social policy and public health as well as those with hands on experience, such as health managers, administrators, public health professionals, and health care practitioners; in particular, it has much to offer those engaged in continuing professional development – and not least politicians, as Ham flags up a mirror inviting them to scrutinise their reflection. Useful suggestions for further reading are also included. These suggestions are laid out at the end of the book – chapter by chapter – providing what a serious student would need and wish for.
The book's erudite contents present a manageable balance between the breadth and depth of health policy in UK. As a result of the devolution of health policy since 1999, the distinctions between England, Scotland, Wales and Northern Ireland are also put forward; dissimilarities are clearly laid out where relevant – indeed Chapter 7 is dedicated to a description of the NHS in Scotland, Wales and Northern Ireland. Yet, Ham's exposition is not entirely UK centric. Chapter 12 provides some comparative statistics of UK NHS performance against health services in other countries. What this chapter does not do, however, is compare health care systems internationally. Such an exercise would place the uniqueness of the British health care model in its global perspective and would have made this excellent text book even more cutting edge, bringing it more fully into twenty-first century global territory. On the other hand, perhaps, such a substantial inclusion would add up to a different book.
Some very significant and reflective insights into the formulation of policies and politicians’ performance can be found in Chapter 13. This chapter also discusses the role of external advisors; the complexities of change and commitment to change; perceptions of service improvements and the impact of changes in ministerial leadership. It brings together current fragmented perspectives of the gains and losses, strengths and weaknesses of approaches to health service reform and argues for a comprehensive approach. Linked to this is the idea of widespread collaboration such as the creation of care networks as well as how best to combine clinical and managerial leadership. Chapter 13 proposes 11 lessons for policy-makers. A possible twelfth lesson could be headed the voice of the patient. This is an important consideration for the way forward. The deep-seated changes within the psyche of an increasing number of current and potential NHS patients are considerable. It is not just about issues of choice or quality of service, it is also about the efficacy, style and consent to western medicine and treatments throughout the twenty-first century.
