Tuesday, 9 April 2013

The Unintended Consequences of Thatcherite Policies

I suggest in this blog that we should not exaggerate the effect of Thatcherism on UK policymaking. Yet, Thatcherite policies often still had a profound impact, often in areas we might least expect. The same article in 2002 (here) outlines the start of National Health Service reforms that may now be taken for granted in England, including: (1) quasi-markets to allocate resources (the purchaser provider split, with health authorities and GP fundholding surgeries often buying the services of hospitals); and (2) the assertion of management hierarchies, with NHS managers challenging the traditional authority of doctors.  

It then shows the unintended consequence of those reforms in a pre-devolved Scotland. Scotland is a ‘best case’ in this regard because we might expect NHS reforms to be implemented in a less extreme way (Scottish Offices were given more time and discretion to implement). Yet, the effect of a ‘power shift’ from providers to purchasers had quite the profound effect on the way that health services were delivered, in an area (HIV/ AIDS policy) previously characterised as distinctively Scottish and often quite removed from UK Government involvement.

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