The reorganised National Health Service

Sixth edition By R Levitt, A Wall and J Appleby Stanley Thornes (Publishers) Ltd 261 pages£22.50

The first sentence of this well-established text puzzled me. It maintains: 'Many people regard the National Health Service as the great success of the United Kingdom's welfare state experiment since 1945.'

Did this mean that the authors had joined the Blairite bandwagon on welfare reform and were about to argue that a 50-year 'experiment' was coming to an end?

In fact, there were no such surprises. Despite some claims that 'the NHS has begun to crumble' and that old values are no longer upheld, the authors' approach remains thoroughly traditional in outlook and presentation.

Now into its sixth edition, The Reorganised National Health Service - which first appeared more than 20 years ago - continues to display a preference for old-style public administration over more modern business-oriented approaches.

But this preference is not pursued relentlessly. On the contrary, strong emphasis is placed on an even-handed narrative of changes in NHS organisation, finance and management over the 50-year period 1948 to 1998.

Readers familiar with earlier editions will find the tried and tested ingredients in this updated version. Considerable space is devoted to chronological accounts of policy development, with a heavy emphasis on legislative changes and official documents. A descriptive, narrative style is used to explain the structure and development of the diverse parts of the system.

The scope of the book is ambitious, including chapters on various aspects of organisation, finance, service provision, performance, human resources, and the public and the NHS. There is little in the way of deep analysis, but the narrative is interspersed with commentary which seeks to give the flavour of debates surrounding initiatives such as GP fundholding and extra-contractual referrals.

Among the chapters not usually found in general texts of this type, there are two dealing with NHS human resources.

One is devoted to a discussion of policy and practice in relation to doctors and nurses, and another to other professions such as dentists, ophthalmic staff and pharmacists.

These chapters offer some useful accounts of, among other things, workforce numbers, education and training, professional self-regulation and pay and conditions.

Given the size and importance of the NHS workforce, it is surprising how so few publications provide the basic information on doctor and nurse training, career progressions and professional regulation of the sort included in these chapters.

Apart from conventional material on NHS organisation, current concerns about quality, performance and outcomes are dealt with in a chapter covering topics such as evidence-based medicine, health outcomes, performance indicators, value for money, accountability and clinical governance.

Financial matters are dealt with in chapters on 'Funding the NHS' and 'The NHS in an International Context'.

In both cases, material that can be somewhat daunting for the less numerate is presented in a clear fashion with imaginative use of graphics.

While there is much useful material in this book, looked at as a whole, I found much of it rather staid.

It is worthy in the old-style social administration sense, but lacks vitality.

There is also too much on historical development and not enough on the challenges of the present and the future. This is particularly noticeable in the case of the final chapter on the NHS and the future, which covers less than eight pages and is based mainly on a perfunctory discussion of priority-setting. Returning to the Blairite theme, I could find no mention of the brave new world of partnership working or the third way.

Professor Ray Robinson London School of Economics.