Wartime hospital policy: attractions and limitations of public– private partnerships
So much has been written about the wartime negotiations on the form of the NHS that further discussion would appear superfluous. However, although the general contours of debates are widely known, a number of technical issues have received rather less attention. The focus here is on the extent to which the various suggestions for post-war policy would, if implemented, have produced the desirable outcome of improved access to services. Although there was some convergence towards ‘hierarchical regionalism’ (Fox 1986), several important questions remained to be resolved if a comprehensive service were to be provided. These concerned how to extend services to locations from which they were absent, how to rationalise services where there was duplication, how to finance extensions to services, how to respond to variations in efficiency between hospitals, and how to devise an appropriate regional organisation. It will be argued that various wartime proposals all failed to resolve at least one of these problems. This was partly because of the limitations of existing knowledge (e.g. on the comparative costs of hospitals) but, more generally, because officials were operating on the assumption that little change would take place in the existing arrangements. Rather than pushing for ideal solutions, policies therefore became bogged down in a series of unsatisfactory compromises.