What does the future hold for the NHS at 60?

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a549 (Published 30 June 2008) Cite this as: BMJ 2008;337:a549
  1. Rudolf Klein, visiting professor
  1. 1London School of Economics, London WC2A 2AE
  1. rudolfklein30{at}aol.com

    Flux and conflict constrained by consensus as in the past

    When the NHS celebrated its 50th anniversary with much pomp, commemorative stamps, and a service in Westminster Abbey, a new Labour government was busy reversing many of the policies of its Conservative predecessor. The internal market was abolished, as was general practitioner fundholding. The NHS would indeed be modernised, but it would be on the basis of cooperation not competition.

    Who then—in the euphoria of the celebrations when Frank Dobson, the secretary of state for health, could claim that “the NHS remains the envy of the world”1—would have anticipated that within a couple of years policy would go into reverse gear? Who then would have predicted the emergence of a new model for the NHS based on choice, competition, payment by results, and a plurality of providers, let alone the emergence of institutions like foundation trusts? To ask these questions is to underline the perils of prediction. It is easy to list the demographic, technological, and other challenges that will face the NHS as it moves towards its 70th anniversary, but quite another matter to be confident about likely policy responses.

    But if the past carries a warning, it also provides some reassurance. From one perspective the history of the NHS is one of flux and conflict. Its …

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