How are reforms carried out?

Health policy

Thomas Gerlinger

Prof. Dr. Dr. Thomas Gerlinger is professor at AG 1: Health Systems, Health Policy and Health Sociology at the Faculty of Health Sciences at Bielefeld University

Kai Mosebach

Born 1970, political and health scientist, substitute professor in the social and health department at the Gochschule Ludwigshafen am Rhein.

The British healthcare system has been in a state of upheaval since the late 1980s. Still planned under the conservative Prime Minister Margaret Thatcher and implemented under her successor John Major, it was decided in 1989 to introduce market elements into the national health service, which had been organized by the state until then (so-called "internal market").

A general practitioner in front of his practice in a supermarket. In order to improve the provision of medical services to the population, in 2008 inter alia. conducted a six-month trial with a doctor's office in a supermarket in Manchester. (& copy picture-alliance / dpa)

Continuity and Change under New Labor (1997 to 2010)

Despite numerous criticisms from the opposition, the Labor government that followed in 1997, under the leadership of Tony Blair, retained the organizational establishment of an internal market in the National Health Service (NHS), but pushed more for the various professional groups in the national health service to work together.

In other areas, however, the government has set new priorities, particularly with the initiation of numerous programs to combat socially induced health inequalities, the importance of which was denied by the conservative previous government. In addition, the Labor government relied on a consistent state strategy to improve the quality of health care, whereby it established a whole series of new (quasi) state authorities.

"The NHS Plan" - a ten year plan to reinvent the NHS

The demographic change of modern societies, medical-technological innovations and the higher demands of patients and citizens towards the NHS make it essential, according to New Labor, to fundamentally reorganize the national health service. New Labor's health strategy focuses on strengthening primary health care over the traditional national health service, which is heavily influenced by hospitals. In 2000 the British government - legitimized by numerous, increasing health scandals and the media scandalized effects of the flu wave with overcrowded hospital corridors and hospital rooms in the winter of 1999/2000 - with the NHS plan ("The NHS Plan - A Plan for Investment, A Plan for Reform ") presented an ambitious ten-year plan with which the English national health service should be fundamentally modernized. The central cornerstones of New Labor's modernization strategy are:
  1. the fight against the waiting list problem by increasing the care capacities and above all an increase in the number of doctors and nurses in the English NHS
  2. improving the quality of health care, clinical outcomes and the health of the population
  3. a stronger interlinking of health and social care for older people against the background of demographic change
  4. a more intensive use of the capacities of the private sector to reduce waiting lists and to increase the options for patients and
  5. the establishment of a stronger patient orientation and patient voice in the national health service through new representation structures and more freedom of choice
To achieve this reform program, Tony Blair's government pledged to sustainably increase public spending on health in order to end the chronic underfunding of the NHS and enable structural reforms. The increase in public health spending is indeed substantial. According to the UK Treasury Department, the nominal health care budget rose from £ 56 billion in 2001 to £ 80.8 billion in 2007, an increase of £ 28 billion in six Years, which corresponds to an annual growth rate of over eight percent. The increase in expenditure has slowed somewhat in recent years.

In an international comparison, the share of public health expenditure in total health expenditure in Great Britain has increased significantly since the NHS plan was announced and went against the trend of decreasing importance of public health expenditure in Germany, the Netherlands and Sweden (see figure "Public health expenditure in Country comparison ").


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