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Background: The UK government's reckless and incompetent response to Covid-19 has produced an outcome which is amongst the worst in the world, and arguably the worst in terms of deaths per 100,000 population of major countries (es...
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Background: The UK government's reckless and incompetent response to Covid-19 has produced an outcome which is amongst the worst in the world, and arguably the worst in terms of deaths per 100,000 population of major countries (especially when one measures mortality from Covid in terms of cause of death on the death certificate, rather than the UK government's own measure-death of a tested individual within 28 days of testing). This article updates my initial analysis in this journal over a year ago, and traces the negligent and shambolic policy-making, and supine official scientific advice, which has led to such a dismal outcome. Methods: It does so by examining the policies and approach of the UK government from the beginingof the pandemic (in UK terms, January 2020) up to June 2021. All relevant declarations, speeches, decisions, public interviews and policies were noted on a daily basis, examined and critically assessed-along with daily data and information over the whole period on Covid's threat to, and spread across, the UK. Conclusions: On three successive occasions, Boris Johnson and his compliant Ministers acted too late and too weakly to prevent avoidable death and illness. At the time of writing the vaccination programme in the UK has been destabilised by the government-yet again-having failed to secure its borders, this time against the Delta variant (Indian mutation) of the virus. Overall, in terms of border control, quarantine, testing, tracing, isolation and timely and enforced lockdown, the government put short-term, superficial considerations above coherent strategy. It dressed up its incompetence as a superficial libertarianism and defence of the economy, but thereby managed to achieve the worst of all worlds in terms of three egregious failures-appalling health outcomes; (ironically) worse economic damage than countries which took draconian action; and (also ironically) continually recurring restrictions as a result of earlier failure to take strong action to suppress Covid and keep it at bay. Public reaction in England (unlike in Scotland and Wales) to the Johnson government's shenanigans has not been commensurate with that government's level of failure, which sadly reflects a debasement of the political culture in England.
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This paper considers health policy-making in the USA with England as comparator. It contrasts policy inertia in US healthcare despite crisis with hyper-activity in perpetual 'reform' in England despite absence of crisis in the NHS...
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This paper considers health policy-making in the USA with England as comparator. It contrasts policy inertia in US healthcare despite crisis with hyper-activity in perpetual 'reform' in England despite absence of crisis in the NHS. It does so from the standpoint of political science and political economy.I suggest that 'path-dependency', the view that past policy constrains future policy, lacks explanatory power and that wider and deeper explanations must be sought. The USA's apparent path dependency is in fact a story of political economy and power, buttressed by institutions. England's apparent lack of path-dependency in promulgating NHS reform is in fact a story of executive hyper-activism which is oblivious to how implementation will obviate its prescriptions.This failure of 'reform' in the NHS is not a symptom of concealed path-dependency but a sign of pragmatism by those charged with implementation. In the USA, the durability of its various systems of healthcare is by contrast a sign of pragmatism not being adequate to achieve health sector reform.In the USA, a weak state is unable to manage healthcare reform which would actually benefit US capitalism as a whole. In the UK, a strong state has created and developed the NHS to the benefit of capital through the economical provision of healthcare to the workforce. Such an 'investment state' is a testimony to the continuing validity of the neo-Marxist argument that social investment and social expenses are an important and functional component of the capitalist state.
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The UK, and England in particular, has suffered egregiously poor outcomes in managing the Covid-19 pandemic. This short perspective points to the explanation in terms of both current British politics and the public health policy i...
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The UK, and England in particular, has suffered egregiously poor outcomes in managing the Covid-19 pandemic. This short perspective points to the explanation in terms of both current British politics and the public health policy inheritance. Boris Johnson’s Premiership was born in an opportunistic assertion of British exceptionalism, and Johnson’s initial, fate-tempting reaction to the novel Coronavirus set the UK on the wrong path. Furthermore, the gradual erosion of professionalism in (especially health) policy-making over almost four decades, and the hollowing-out of the health protection infrastructure, both facilitated and accentuated a toxic approach to managing Covid-19.
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In the article, ‘Learning Lessons from the Covid-19 Pandemic’, Powell (2022) rightly implies that there is a profusion of confusion in the ‘industry’ which has grown up around lesson-learning from the pandemic. His contributio...
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In the article, ‘Learning Lessons from the Covid-19 Pandemic’, Powell (2022) rightly implies that there is a profusion of confusion in the ‘industry’ which has grown up around lesson-learning from the pandemic. His contribution sets out a helpful framework for classifying or making attempts at lesson-learning. He combines the tripartite classification of inadequate approaches to policy-learning and policy transfer developed 30 years ago by Dolowitz and Marsh (‘uninformed-incomplete-inappropriate’), which he inverts to produce a classification of approaches which are informed, complete and appropriate, with the framework of ‘outcome-mechanism-context’ from realistic evaluation. (I use the term realistic rather than realist, as the latter implies an epistemological stance as opposed to what was intended, which is that evaluation takes account of complexity in a realistic manner.) This produces a classification, and possibly an ‘ideal type’, of informed outcomes, complete mechanisms and appropriate context. Powell rightly implies that no overall conclusion is available from the literature reviewed. He does however imply that different approaches may work in different settings. This is true in one sense but misleading in another. This commentary argues that such ‘relativism’ is not only dangerous in practice but mistaken in theory.
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Walter Holland is-to borrow a word he employs to describe some key figures in the history of health services research (p.67)-a giant. He has been at the forefront of health services research in the UK, Europe and globally for many...
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Walter Holland is-to borrow a word he employs to describe some key figures in the history of health services research (p.67)-a giant. He has been at the forefront of health services research in the UK, Europe and globally for many years, and this book is testimony to his leading role not only in doing and directing such research but also with regard to that often-difficult place where research meets-or does not meet-policy. For those who wish to reflect critically and constructively upon what health services research and health policy-making could and should look like, more insight will be gleaned here through his personal story and accompanying thought than from many formal considerations of the question from official panels of scientists and social scientists.
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The NHS reforms have come to mean all things to all men (and women). Identifying a market oriented purchaser-provider split as the conceptual heart of the reforms is still, however, useful. There are important perverse incentives ...
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The NHS reforms have come to mean all things to all men (and women). Identifying a market oriented purchaser-provider split as the conceptual heart of the reforms is still, however, useful. There are important perverse incentives in and around the NHS that are associated with the reforms; furthermore, many reactions to the resulting problems are paradoxical and often counterproductive. Hitherto most criticism of the reforms from the health policy and management community (as opposed to the professions and the public) has been tactical rather than fundamental. There are serious problems for the NHS associated both with the NHS market and with current, often tacit, strategies for the future of the service.
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With hindsight, the 1970 second edition of Thomas Kuhn's The Structure of Scientific Revolutions has had more influence in the social sciences than in the natural sciences to which it was directed. His notion of 'paradigm' is quot...
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With hindsight, the 1970 second edition of Thomas Kuhn's The Structure of Scientific Revolutions has had more influence in the social sciences than in the natural sciences to which it was directed. His notion of 'paradigm' is quoted frequently in the social sciences. Yet there are two Kuhns - the benign and the baleful. He is one of those seminal thinkers who is often misunderstood despite his clarity of writing - principally, I suspect, because many of those who use the notion of paradigm may not have read Kuhn, let alone had a 'second look'. For many, the notion of paradigm is associated with - is even an excuse for - relativism in both epistemology and ontology. Of course, Kuhn and more contemporary sources of relativism - the likes of postmodernism and post-structuralism - are worlds apart by intellectual origin. Yet a certain tendency within academe is so concerned to reject a straw-man version of positivism, and to over-privilege ethnographic knowledge of how individuals and cultures 'understand', that relativism from whatever source ends up ruling.
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This first issue for 2014 has a wide variety of topics applied in different regions of the world, as well as articles providing conceptual and methodological developments, drawing upon different disciplines in the social and behav...
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This first issue for 2014 has a wide variety of topics applied in different regions of the world, as well as articles providing conceptual and methodological developments, drawing upon different disciplines in the social and behavioural sciences.The first, by Efstathiou, Papastavrou and Andreou, explores rationing in nursing care and nurse-patient outcomes through a systematic review of quantitative studies.The second, by Fenenga et al, asks whether prevailing theories sufficiently explain perceptions of health and of health-seeking behaviour in Ghana.The third, by Gandjour, explores the salience of health care expenditures from living longer.
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This issue is a 'special issue' devoted to China - the People's Republic of China, followed by a couple of articles on Taiwan. Additionally, there are a few articles in the 'online' section on other topics set in other countries.T...
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This issue is a 'special issue' devoted to China - the People's Republic of China, followed by a couple of articles on Taiwan. Additionally, there are a few articles in the 'online' section on other topics set in other countries.The significant change and reform in PRChina provides large scope for input to an additional issue, to follow up our earlier one. Furthermore, there are articles on the health-care system generally - and on specific aspects of the system - and the challenges it has to face.
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