Book Reviews
Betraying the NHS: Health abandoned
Michael Mandelstam (Jessica Kingsley Publishers, 2007. Hardback
£14.99)
This would be a perfect book to give, for instance, to a foreign
visitor or ‘non-health relative’ who wanted to understand what has
been happening to the NHS in recent years and what it has felt like for
patients, staff and citizens. Mandelstam sustains an informed, articulate and
smouldering sense of justified outrage, mainly about authorities overriding
expressions of local needs, particularly of the most vulnerable.
The book was written “against the backdrop of fundamental
changes being made to the National Health Service in England during 2005 and
2006”. It consists mainly of a very well-written account of how health
policy changes affected local communities in Suffolk, and particularly West
Suffolk, and how health authorities rode roughshod over public and NHS
staff.
Michael Mandelstam has provided legal advice and training on
health and social care to the NHS, local authorities and voluntary
organisations for over ten years. Before that he worked for ten years at the
Disabled Living Foundation and for several years in the Department of Health.
He has written a number of widely used legal books, including Community Care
Practice and the Law, and Equipment for Older and Disabled People and
the Law.
Based on his experiences of helping to fight cuts and closures in
Suffolk, the author delivers a damning verdict on the mismanagement of the NHS
nationally, regionally and locally. Mandelstam describes lucidly how changes in
the NHS were driven by concealed agendas, including privatisation, and resulted
in damaging decisions which adversely affected many people and particularly
older people with chronic and complex needs, people with physical or learning
disabilities and people with mental health problems. He also pays due attention
to the almost total lack of democracy and accountability nationally and
locally.
Mandelstam does not however give the reader a public-health
perspective covering items such as close analysis of old or current epidemics,
from obesity to binge drinking; changes to NHS budgets (he, like the rest of
us, has to struggle with New Labour financial opacity); or changing death
rates; or the impacts on waiting lists. Nor does he analyse the misty locations
where the massive and essentially reactionary changes to the NHS have come from
and the complex politics and practices of NHS privatisation (especially
‘patchwork privatisation’) and linked changes aimed at
de-professionalisation. (For that story one perhaps needs Dexter
Whitfield’s important book New Labour’s Attack on Public
Services; Spokesman Books). But Mandelstam tackles a lot – and well.
Not least, he is outstandingly readable.
PETER DRAPER
Consultant in Public Health
A Stifled Voice: Community Health Councils in England
1974-2003
Mike Gerrard Former Director of ACHCEW 1997-1983
Pen Press Publication, Brighton. 2006. Paperback £9.50
The book begins with the Labour government’s decision in
2000 to abolish Community Health Councils (CHCs) in England, the manner in
which it was conveyed and the response it provoked. It discusses the decision
itself and the broader attitude of the government, offering comments from the
previous Secretary of State for Health and others suitably qualified, including
the chairman of the House of Commons Select Committee on Health at the time.
Having thus set the scene, it goes back to the early 1970s where
the story begins, outlining the debate and the processes leading to the
creation of CHCs in the 1973 legislation; their establishment under the
Conservative government and the changes made almost immediately afterward by
the incoming Labour government. It covers the support given to CHCs and their
staff to get them going, the argument over a “national council” or
a national association, and its resolution.
The means chosen by the government for the organisation of CHCs
was to make the Regional Health Authorities (RHAs) responsible for them. These
processes are discussed, and some attention given to the long-term relationship
that developed, with selected recollections from a number of the people
involved.
The first major crisis in the life of CHCs took place during the
early days of the Thatcher government, and the upheavals of this and the
succeeding period are covered in two chapters taking the historical account
through to the end of the 1980s.
A fluctuating relationship with the government and the Department
of Health characterised the early 1990s. CHCs were given greater resources,
RHAs were abolished, and the Association of CHCs (ACHCEW) was engaged in a
constant search for workable performance standards for CHCs, culminating in the
appointment of management consultants to find a solution.
The consultants’ report was quickly followed by the 1997
change of government but the search for measurable standards went on. Thinkers
in the CHC world were facing up to the political imperatives of the time:
recording the successes of CHCs and arguing for changes in direction perceived
as necessary. Donna Covey, the new Director of ACHCEW introduced a number of
positive initiatives, but fate intervened
The book concludes with my own appreciation of CHCs, and some
thoughts on events since 2003, and the future for public involvement in the
NHS.
MIKE GERRARD
Former Director of ACHCEW
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The NHS Consultants' Association
