We discuss and evaluate the validity of this claim, particularly in the context of the National Health Service (NHS) of UK. The discussion is carried out at two levels: first a descriptive assessment of some important theories of organisational change and secondly, an examination of their relevancy to changes in NHS of UK.
The UK's National Health Service (NHS) came into operation on the fourth of July 1948. It was the first time that completely free healthcare was made available on the basis of citizenship rather than the payment of fees or insurance premiums. The service has been beset with problems throughout its lifetime, not least a continuing shortage of cash. (BBC, 1998). In January 2000, two decades of relative resource constraint on the NHS were ended by the commitment to raise UK health expenditure to the European average. After that commitment there were two ambitious reform plans (The NHS Plan, 2000; Wanless 2002) together with an expressed preference for the UK's unique tax-based system (Wanless 2001). The 2002 Budget raised national insurance contributions to fund a real increase of 43% in NHS spending by 2007-8, thereby raising health expenditure from 6.8% to 9.4% of GDP.
For all organisations financing their operations is a prime concern. ...
he UK had a conventional mix:90% of the workforce had social insurance, covering the GP service and sick pay, the other 10% and all dependants either had private insurance or made full out-of-pocket payments. The Beveridge Report in 1942 recommended a service that was universal (covering all people) and comprehensive (covering all needs). Bevan nationalized the hospital system in 1948 and made national rather than local taxes to fund the service.In the mid 1950s, the Conservatives questioned the desirability of a tax-funded NHS on ideological and economic grounds. Increased affluence meant most people could, and arguably should, provide directly for their own health care.However, the national insurance contribution was raised three times between 1957 and 1961. This option was favoured because it proved to be an uncontroversial way to raise the needed revenue for public health services.The drive to make the NHS fully, or more fully, contributory was halted in 1962 by Enoch Powell, who as minister of healthlaunched an alternative Hospital Plan, which he described as 'an opportunity to plan the hospital system on a scale which is not possible anywhere else on this side of the Iron Curtain'.The Plan was overhasty, drawn up in four months by Regional Hospital Boards with little experience of, and skills in, long-term planning. It was said to be like 'giving a blind man a stick - it might help but it would not improve his sight'. In the 1980s, there were two attempts to alter the financial basis of the NHS. Both failed and resulted in the explicit re-endorsement of the tax-based system. By 1987, the NHS was near bankruptcy because its income from government was so restricted. A proposed hypothecated health tax, from which people might opt out into private health insurance,