Making Sense of the NHS White Papers

This is the second edition of Professor Baker’s guide to the plethora of NHS White papers that have appeared since the general election in 1997. It provides an insight into recent developments in the NHS from an ‘insiders’ viewpoint but handled with a passion for his subject and analytical of the proposals. Professor Baker is well able to provide such an analysis for he is Medical Director of North Yorkshire Health Authority, a visiting professor at York University and the University of Bradford. Over the past 20 years he has held many senior posts in NHS management. He starts by explaining and analysing the problems that beset the Labour government on taking office from crisis through the political personalities involved to the policy and funding implications. To quote from his view on policy ‘Most new governments reorganise the NHS. It is not that there is any evidence that such changes are desirable, necessary or successful, merely that it is within the power of government to take such action.’ Professor Baker describes the changes proposed in White Papers, the impact those changes will have on the working lives of the NHS workforce, the underlying policy theme and the possible scenarios of implementation and their consequences. The book then has sections on the White Papers and the subsequent consultation documents with greatest emphasis given to ‘The New NHS: modern dependable’. This is followed by parts on Health Improvement, Quality, Primary Care and the Future. Good boxed sections summarise the papers and a useful reading list lists the documents (a formidable list!) Professor Baker explains the thinking behind Labour’s approach then carefully looks at the content of the papers. In this he is probing, questioning and critical. The reader will be better armed to consider the roll out of policy and implementation of these key papers. Professor Baker explains the conflict between aspirations and expectations of the professions and government: ‘Doctors have long believed that only they can and should decide what needs to be done to improve services and it is the responsibility of government to pay for what they want to do. While government decides political priorities and expects its paid servants, including NHS doctors, to deliver for it!’ He is not afraid to express his views forcibly, often in conflict with successive government approaches. In this his own prejudices obviously appear. This will clearly be seen by readers in the conclusions when two potential scenarios; one cynical, the other idealist appears. Not everyone will agree with these outcomes but they provide food for considerable thought. Dentistry has scant mention in the book — Professor Baker believes that there is no real idea of where the other contractor professions fit in — we may learn this shortly with ‘A Strategy for NHS Dentistry’ certainly Tony Blair has raised dentistry’s profile recently. The book is an extremely readable, idiosyncratic view of recent events with a hardheaded cynicism and recognition of the problems. The reader will be entertained, informed and stimulated. [BR822] W. R. Allen