Abstract
Last year (1998) saw the celebration of the 50th Anniversaryof the British National Health Service (NHS). One ofthe few completely nationalised systems of health carein the world, the NHS is seen by many as a moralbeacon of what it means to provide equitable medicaltreatment to all citizens on the basis of need andneed alone. However, others argue that it has failedto achieve the overall goals for which it was created.Because of scarce resources, some urgently needed careis not available at all, while that which is receivedis sometimes second class. For these reasons, it isclaimed that the NHS should be scrapped and replacedby other systems of health care delivery.This paper outlines the history of the NHS,indicating some of the problems and innovations whichhave led to its current organization and structure.The philosophical foundations of the NHS are then articulated and defended on the grounds that it stillrepresents a morally coherent and economicallyefficient approach to the delivery of health care.Scarce resources are the key problem facing the NHS,making rationing inevitable and it is shown thatthis is not incompatible with the moral foundations ofthe service. However, there can be little doubt thatthe NHS is now becoming dangerously under-funded. Thepaper concludes with arguments about why this is soand what might be done about it.
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References
Andrulis, D.P. (1998) Access to Care is the Centrepiece in the Elimination of Socioeconomic Disparities in Health. Annals of Internal Medicine 129, 412–441.
Annas, G. (1998) Human Rights and Health - The Universal Declaration of Human Rights at 50. The New England Journal of Medicine 339, 1777–1781.
Appleby, J. (1992) Financing Healthcare in the 1990s. Buckingham: Open University Press.
Appleby, J., Smith, P., Ranade, W., Little, V. and Robinson, R. (1994) Monitoring Managed Competition. In: R. Robinson and J. Le Grand (Eds.), Evaluating the NHS Reforms (pp. 24–53). London: King's Fund Institute.
Beveridge Report (1942) Inter-departmental Committee on Social Insurance and Allied Services, cmnd.6404. London: HMSO.
Beecham, L. (1999) NHS Crisis Caused by Gradual Attrition. British Medical Journal 318, 267.
Bell, J. and Mendus, S. (Ed.) (1988) Philosophy and Social Welfare. Cambridge: Cambridge University Press.
Dixon, J. and Harrison, A. (1997) Funding the NHS: A Little Local Difficulty. British Medical Journal 314, 216–221.
Dixon, J. and Mays, N. (1997) New Labour, New NHS? TheWhite Paper Spells Out Evolution not Revolution. British Medical Journal 315, 1639–1640.
Doyal, L. (1995) Needs, Rights, and Equity: Moral Quality in Healthcare Rationing. Quality in Health Care 4, 273–283.
Drummond, M. (1993) Health Technology Policy and Health Service Research. In: M. Drummond and A. Maynard (Eds.), Purchasing and Providing Cost-effective Health Care (pp. 94–108). Edinburgh: Churchill Livingstone.
Edgar, A., Salek, S., Shickle, D. and Cohen, D. (1998) The Ethical QALY (pp. 1–24). Haslemere: Euromed.
Enthoven, A. (1985) Reflections on the Management of the National Health Service. London: Nuffield Provincial Hospitals Trust.
Frankel, S. and West, R. (1993) What Is to be Done? In: S. Frankel and R. West (Eds.), Rationing and Rationality in the National Health Service (pp. 115–131). London: Macmillan.
Griffiths, R. (1983) NHS Management Inquiry. London: DHSS.
Grimley, Evans J. (1993) This Patient or that Patient? In: Rationing in Action (pp. 118–124). London: BMJ Books.
Harrison, A., Dixon, J., New, B. and Judge, K. (1997) Funding the NHS: Is the NHS Sustainable? British Medical Journal 314, 296–329.
Horton, R. (1993) Towards a National Health Service. Fabian Review 105, 11–12.
Horton, R. (1998) The Realpolitik of a New National Health Service for the UK. Lancet 351, 76–77.
Hart, J.T. (1973) Bevan and the Doctors. Lancet 2, 1196.
Klein, R., Day, P. and Redmayne, S. (1999) Managing Scarcity: Priority Setting and Rationing in the National Health Service (pp. 63–82). Buckingham: Open University Press.
McKeown, T. (1979) The Role of Medicine: Dream, Mirage or Nemesis. Oxford: Blackwell Scientific.
Mitchell, P. (1998) UK Health Service Benefits in Public Spending Review. Lancet 352, 298.
Morgan, O. (1998) Who Cares? The Great British Health Debate (pp. 123–148). Oxford: Radcliffe. OECD Health Data 1999.
Plant, R. (1992) Citizenship and Rights. In: D. Milligan and W. Miller (Eds.), Liberalism, Citizenship and Autonomy (pp. 88–107). Aldershot: Avebury.
Rawls, J. (1972) A Theory of Justice (pp. 19, 92-93). Oxford University Press.
Rivett, G. (1998) From Cradle to Grave: Fifty Years of the NHS. London: King's Fund.
Stevens, A. and Gillam, S. (1998) Health Needs Assessment. British Medical Journal 316, 1448–1452.
Saltman, R.B. and Figueras, J. (1998). European Health Care Reform: Analysis of Current Strategies. Geneva: WHO.
Secretaries of State for Health. Wales, Northern Ireland and Scotland (1989). Working for Patients. London: HMSO.
Strosbeerg, M., Wiener, J. and Baker, R. (1992) Rationing America's Medical Care: The Oregon Plan and Beyond. Washington: Brookings Institution. Sunday Times, July 11, 1999.
Webster, C. (1998) The National Health Service (pp. 1-64). Oxford, Oxford University Press.
Winslow, G. Triage and Justice (pp. 87-110). Berkeley: University of California Press.
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Doyal, L., Doyal, L. The British National Health Service: A Tarnished MoralVision?. Health Care Analysis 7, 363–376 (1999). https://doi.org/10.1023/A:1009470500920
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DOI: https://doi.org/10.1023/A:1009470500920