Health care in the community

The Politics of Change in the Health Service - Beyond the Welfare State? The New Political Economy of Welfare - Community Care
November 27, 1998

Few will have escaped often impassioned debates about "community care" of the past decade. One admirable feature of Community Care: Policy and Practice is that it early on explores the meaning and symbolism of "community", which allows the reader to reflect on whether community care might be a good thing or not.

As an overview of community care during the 1990s, this book has much to recommend it. Aimed at students in courses for the caring professions, social policy students and "the reflective practitioner", its tone and style are well judged, although two shortcomings merit mention.

One is the paucity of statistics. If readers want answers to questions such as "How many elderly people cope without state intervention?" or "How does the number of day hospital places vary from region to region and what do they cost?", they will need to look elsewhere.

The other shortcoming is the emphasis on problems of policy implementation rather than on policy formulation. Politicians have reasons for promoting community care for the elderly, the disabled and the mentally ill. Without analysing these, the attempt to answer the question why community care policies have achieved such prominence is unsatisfactory.

Students thirsty to understand the wider dimensions of welfare state policy would do well to turn to Beyond the Welfare State? The New Political Economy of Welfare , a book aimed at second- and later-year undergraduates in mainstream social sciences (and the general reader). It takes you rapidly up the learning curve of competing theories of the welfare state and social democracy in advanced capitalism. Its sweep is wide, it is well-ordered and up to date. Most welcome of all, it is clear.

In contrast, The Politics of Change in the Health Service gives a focused account of mechanisms of change in the NHS. The book progresses by examining professional groupings (both medicine and nursing are considered) and functional units (such as primary care and hospital providers). It is careful and analytical in approach, providing more statistical information and describing far less than more basic text. But the content is less overtly theoretical than many books with similar titles. It therefore gives more insight into and constructive criticism of health care organisation and delivery than its competitors.

This is an authoritative account, which also seems generally well grounded in an understanding of the system. Its one limitation is that the important transition of purchasers into commissioners of health care receives scant attention. Most organisations in this category now recognise that a purely contractual relationship with those who provide clinical services has grave limitations, and that more diverse approaches to influencing health care are required.

The book is densely written but clear and well referenced. It is probably beyond new undergraduates, but it has a place in undergraduate and postgraduate courses in health care, public health and related social sciences. It is also an informative guide to any reflective health care professional or manager.

Mark Lambert is clinical lecturer in health sciences and clinical evaluation, University of York.
Neil Pettinger is performance review manager, Royal Infirmary of Edinburgh NHS Trust.

The Politics of Change in the Health Service

Author - Brian Slater
ISBN - 0 333 65640 7 and 65641 5
Publisher - Macmillan
Price - £45.00 and £14.99
Pages - 257

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