Universality, equity, and quality of care

Universality

Everyone who is “ordinarily resident” in the United Kingdom has the right to free primary and secondary care provided by the NHS. Until earlier this year, failed asylum seekers were deemed not to be ordinarily resident, but a judicial review has successfully challenged the lawfulness of Department of Health guidance on this point.2

Otherwise, this founding principle seems the least contested of all. From time to time it’s argued that certain categories of patients should be excluded from certain treatments—usually based on disapproval of their lifestyles (smoking, obesity, etc)—but these are mostly half hearted attempts that don’t get very far.

Equity

Although the words “equity” and “equality” do not feature in documents from the early days of the NHS, there are enough pointers to conclude that the service was intended to provide equal access or actual treatment for those in equal need. The concept has been refined since then. An equitable health service is currently understood to mean “one where individuals’ access to and utilisation of the service depends on their health status alone.”3