A Critique of Priorities for Health and Personal Social Services in England

Abstract

Priorities for Health and Personal Social Services in England was prepared by the Department of Health and Social Security (DHSS) as a basis for consultation about its intended policies during the period 1975–1976 to 1979–1980. The decision of the DHSS to engage in consultation with interested parties is, of course, to be welcomed. However, the Priorities document leaves much to be desired both in terms of the quality and quantity of information provided and in its treatment of the pressing issues affecting the health and personal social services. Many of the areas labeled as priorities show no increase in the proportion of the budget devoted to them; some, in fact, show a definite reduction. Other so-called “growth areas” show such low rates of expansion that they will barely keep pace with the needs of the increasing number of elderly in the population. Many Area Health Authorities are reducing services in acute specialties, despite long waiting lists and the fact that over 80 percent of admissions of elderly patients are to acute wards. Thus, such cuts are likely to increase even further the demand for geriatric facilities. Many of the areas designated for expansion by the DHSS are largely under the financial control of local government, which is in many cases reducing these services. The most rapid rise in expenditure will be on pharmaceuticals. This will account for the largest increase within the primary care system, leaving little room for any improvements in the service. In an associated document, Prevention and Health: Everybody's Business, the DHSS attempts to demonstrate that specific preventive measures have been the most important factors in major changes of disease patterns and ignores the importance of secular changes. There is no discussion of the relationship between social structure and both disease and delivery of care; instead, the focus is on individuals changing their life-style as a result of being provided with the appropriate information. There is already evidence that this approach yields poor results and that alternative strategies are needed. Unfortunately, the DHSS seems unable to provide leadership for their development. These two documents give little hope that genuinely new initiatives will come from the DHSS. Whatever the initial intentions behind their publication, it now seems unlikely that “consultation” will prove to be anything more than a smokescreen behind which cutbacks in services can occur. True consultation implies availability of accurate information about the health and personal social services, together with a program of public education far more comprehensive than that which is currently envisaged.