Private Complaints and Public Health: Richard Titmuss on the National Health Service - Edited by Oakley, A. and Barker, J.

Oakley, A. and Barker, J. (eds) Private Complaints and Public Health: Richard Titmuss on the National Health Service . Bristol : The Policy press , 2004 . ISBN 1-86134-560-7

This book consists of a compendium of the writings on health of Richard Morris Titmuss, one of the 20^th century's foremost social policy thinkers. It is in four distinct parts, each containing four or five chapters, which have been put together, along with a commentary, by different contributors in the field. The editors argue that even though Titmuss's work is somewhat dated, many of the issues with which he dealt remain highly relevant to contemporary society. Oakley and Barker assert that the title of their book stems from one of Titmuss's early papers (reproduced for this volume) where he states that the advent of the NHS converted private complaints to public ones. A key aspect of Titmuss's work, they argue, is the tension between science- or evidence-based medicine and the therapeutic importance of other aspects of healthcare which are more difficult to measure, for example people's capacity to care for each other. Each commentator has, in their own particular way, reflected upon the work of Titmuss and how it relates to health and healthcare in recent times.

The first part, entitled Social Medicine and Social Inequality, has been collated by Michael Wadsworth and considers the work of Titmuss in light of the social medicine movement, seen at the time as the ‘radical’ side of public health. It brings together some of his key work on the use of evidence as the basis for developing policy. Titmuss might not have been the first in the UK to link together social factors and disease, but he was certainly at the very forefront of the movement. As Wadsworth points out, the collection of articles in this part of the book highlights some of the methodological innovations of the time, and especially the arguments for cause and effect in terms of social and ecological conditions, and disease.

Part two is entitled The National Health Service and commences with a thought-provoking commentary by John Ashton. In contrast to Part One, this section of the book parallels many of the current issues and arguments around the NHS in the 21^st century. Here, the essays by Titmuss focus on the structure and organisation of healthcare provision, something that remains high on the Government agenda to this day. By far the most interesting, for this reviewer, is the final chapter in this section on the ethics and economics of medical care, throwing up as it does the very pertinent issues of consumer sovereignty and private vs public medicine. Reading this section helped me to see much more clearly the uniqueness of the UK healthcare system. This is no bad thing – one is often forgetful of the fact that, despite the many social injustices in the experience of health and disease, the NHS was founded on principles of equality of access, and free care at the point of delivery. Part three, The Sociology of Health Care, compiled by Jonathan Barker and Janet Askham, incorporates essays on healthcare using what they term ‘an emerging sociological perspective’. In this section of the book readers can consider some of the very topical issues of the 21^st century, written by Titmuss in the middle of the 20^th century. These include social and psychological factors in relation to healthcare, as well as the impact of technological change. Also in this part is a very pertinent chapter on healthcare for older people.

As Julian le Grand notes, in his commentary for Part Four, entitled Health, Values and Social Policy, this final section of the book also deals with issues that are very relevant today. Although Titmuss wrote about the conflict between public versus private practice, consumer choice, and the tensions between financial incentives and altruism, more than 30 years ago, these dilemmas are still faced. A fascinating read for medical sociologists in the making as well as public health practitioners, this book throws up some thought-provoking issues which, although not changing over the years (and this is part of the appeal of this book); it demonstrates that the difficulties of addressing poverty and health, or the structure of provision are not only the province of the 21^st century but have preoccupied successive governments, healthcare professionals, social policy analysts and the like for decades. If you do nothing else, read the prologue, where the reader is treated to a deeper insight into the mind of Titmuss, and makes one wish one had seen and heard him give one of the lectures contained within this volume.