Ideology, class and the National Health Service

Since the start of the British National Health Service, disputes between the government and the medical profession have become formalized battles with well-recognized rules. But between 1974 and 1976 the consensus underlying the conflict was challenged by the Labour Government's policy on private practice and pay beds. This paper examines the course of the conflict and analyzes the factors underlying the eruption of this issue. It draws attention to the role of the trade-unions in activating the Labour Party's latent ideological commitment on private practice. Although the issue appears to conform to a class-conflict model, this simple symmetry becomes blurred on closer analysis. In conclusion the paper argues that while socio-structural factors extrinsic to the health service explain the appearance of private practice on the political agenda, it is factors endogenous to the NHS which explain the outcome of the dispute. In turn, however, these endogenous factors have little to do with the fact that the NHS is delivering a commodity called "health." Instead, what is important is that the NHS is a complex organization and, as such, depends on the co-operation of a variety of groups--ranging from the medical profession to laundry workers. The analysis, therefore, concludes that the power of the medical profession derives not from its elite status but from its position as an organized group in a complex industry.     

Governance and Regulation of the Peruvian University System: Overcoming Reform Resistance through Quality Assurance Policies

This article examines the new governance of the Peruvian university system, which evolved in response to market liberalisation and weak quality assurance mechanisms. New actors and commercial interests emerged, building their network of relationships within the political arena. With the passing of a new Universities Law in 2014, ambitious reforms were set in motion, designed to reverse the decline in the quality of higher education. This study examines these reforms, focusing on whether and how they are changing the governance and structure of the system. It also identifies some conceptual and design flaws, such as the weaknesses of the main steering body and the accreditation regime, as well as limitations on the independence of the regulatory agency.