Christopher Deeming

Footnotes Competing interests None declared.

Britain's New Labour government will spend some 133 billion this year on social protection for vulnerable groups with low incomes such as pensioners, disabled people, and working families with and without children. It also regularly reviews the National Minimum Wage for workers. Although its intentions are laudable, the government can be criticised for setting income floors with little or no grounded assessment of individual welfare requirements. Budget standards, originating in Rowntree's work on poverty at the close of the nineteenth century, offers an alternative for setting minimum incomes. Used by Beveridge in 1942 to rationalise the proposal for social security levels, they have largely been neglected by successive governments and were recently rejected by New Labour in its review of child poverty measures. Academic research, however, continues to identify non-arbitrary income thresholds. The transparency of evidence to maintain a defined standard of living along with the minimal personal costs involved are key attractions. The challenge remains to find a generally acceptable standard. How much emphasis should be given to scientific prescriptions for health compared to popular cultural practices captured by national surveys of poverty and social exclusion or agreed by the consensus of ordinary citizens in focus groups? This article considers the current debate within UK social policy.

In July 2000 Britain's New Labour government set a target of 20,000 extra nurses for the NHS by 2004. In February 2002, two years ahead of schedule, the target was achieved. The government is to be congratulated on meeting its target but ethical questions over recruitment practices remain. Nurse registrations to the UK from the (then) fifteen EU countries remain flat despite government guidance making this the first priority for international recruitment. Registrations from developing countries with nursing shortages continue despite repeated guidance discouraging this. The government appears to have been caught in a policy bind. On the one hand it needed to be seen to be acting to prevent “poaching” while waiting for fresh intakes of trainees to come through; on the other, if it had succeeded it would have struggled to meet a key policy pledge and certainly not ahead of schedule. New Labour's stated commitment to an ethical foreign policy seems more apparent than real. The paper reports a clear dissonance between the thrust of national policy on nurse recruitment and current employment practices within the UK.

Footnotes Competing interests None declared.

The aim of New Labour's health policy is to shift more of the balance of power and responsibility for services to the local level. But, while the government proclaims a new decentralized NHS, doubts exist about the extent to which the reality on the ground matches the tone of policy. This article reports empirical work examining the level of autonomy purchasers have over budgetary allocation. A case study analysis of purchasing within a single district was undertaken for the financial year 2001/2 which included semi‐structured interviews with key officers responsible for budget allocation. Purchasers approach a new financial year with a starting position that matches the previous year's allocation—the “baseline”, this is adjusted for inflation and, as has happened over the last few years, increased further in real terms by “growth funds” for service modernization and government initiatives. The analysis shows a clear dissonance between policy and practice; although purchasers have complete control over their “baseline budgets”, the study found that this does not “ring true” at the local level. Only about a fifth of growth funds were at the discretion of purchasers as most are taken by national priorities and pay and price inflation. Further decentralization is planned, which includes transferring more control of funds to primary care trusts by 2004, the extent to which these measures will change the perceptions of those working in the service remains to be seen—only then will the government be able to claim a truly decentred service.