The past and future of the NHS: new labour and foundation hospitals

The government's current policies on hospital provision rest on a partial critique of previous attempts at planning health care. New Labour alleges that the National Health Service's monolithic, top-down structures have failed to deliver an equitable service, and argues that the recuperation of what is claimed to be a neglected mutualist tradition in British socialism can rectify the democratic deficit in health care.Developments under the NHS cannot be characterised simply as a top-down bureaucracy in the current fashion of government spokespersons. For this fails to acknowledge the real achievements of central planning in improving the distribution of resources. And it is arguable that the failures of top-down hospital policy were due as much to external circumstances as to technical weaknesses in the ability to plan services.The inter-war period, characterised as a mixed economy of welfare, should not be celebrated as a positive example of localism, and its health-care system should not be celebrated as a positive example of mutualism. New Labour's proposals may indeed merely reproduce the shortcomings of the unrepresentative governing bodies of pre-NHS hospitals.The establishment of foundation hospitals is being pursued for largely pragmatic and electoral reasons, with the attendant (but not publicly acknowledged) risk of fragmenting and dividing the service, and of reproducing features which the supervisory and regulatory state of the 1930s was unable to deal with satisfactorily