Letters NHS reforms

Is the NHS only a means of delivering healthcare?

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d983 (Published 15 February 2011) Cite this as: BMJ 2011;342:d983
  1. Gareth Forbes, general practitioner1
  1. 1Leadgate Surgery, Consett, County Durham DH8 6DP, UK
  1. garethforbes{at}nhs.net

I do not agree that the NHS “is only a means of delivering healthcare.”1 The underpinning principle of the NHS, that the more fortunate (in terms of affluence and health) help those who are less fortunate, is an attractive one. It relies on the fact that all citizens are engaged with the NHS as patients, potential patients, or contributors; that receipt of NHS “benefits” varies with need; and that size of contribution varies with capacity to contribute. The NHS helps to promote civic virtue and contributes to the values of British society; it helps to reduce inequality (most obviously by preventing bankruptcy as a result of ill health) and promote social cohesion (the NHS being an institution where different groups mix and share). Because inequality and social cohesion are important determinants of health, the structure of our healthcare probably affects health and wellbeing independently of the direct effects of preventive and therapeutic interventions. In addition, the values inculcated by the NHS might spill over into other areas of life.

I don’t argue that the NHS doesn’t need reform or that it should not continually strive to improve quality and efficiency, but that the wider implications of reform must be considered—that is, that the design of our healthcare system contributes to the values and nature of our society.


Cite this as: BMJ 2011;342:d983


  • Competing interests: None declared.


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