The Association of Metropolitan Authorities has recently proposed that responsibility for the NHS should pass from health authorities to local authorities.
One of the fiercest debates at the outset of the NHS was whether the hospitals should be run by local authorities.
In the end the minister for health, Aneurin Bevan, decided against local democracy and in favour of a national health service.
His arguments included the fact that equality of treatment could not be guaranteed if facilities varied with local finances and that even the largest authorities were not big enough to pool risks and expertise.
All these arguments still apply today, and the recent changes in community care provide an insight into how a market model of local authority control might work.
The changes have been accompanied by a shift from public to private sector provision and the introduction of charges for services that the NHS once provided free.
As important, the willingness and ability of local authorities to raise extra revenue from local taxes and charges affect the service they can provide, so leading to inequalities of provision.
Local authorities have yet to make the case that they can preserve the fundamental principles and benefits of the NHS, including its reliance on central taxation and unified funding formulas.
Mots-clés Pascal : Organisation santé, Autorité, Echelon national, Echelon local, Service santé, Politique sanitaire, Royaume Uni, Europe
Mots-clés Pascal anglais : Public health organization, Authority, National scope, Local scope, Health service, Health policy, United Kingdom, Europe
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0394523
Code Inist : 002B30A01B. Création : 01/03/1996.