The NHS reforms revisited

Health care systems change as societies change

Born amid anger and bitterness, the 1991 reforms of the NHS continue to be a subject of controversy. No consensus about the balance of costs and benefits has emerged, and disagreement about the NHS will doubtless feature as prominently in the next general election campaign as it did in the previous two. Not only is the available evidence about the NHS's record since 1991 fragmentary and often ambiguous, but the fiercely partisan positions taken up by advocates and critics when Kenneth Clarke launched Working for Patients1 in 1989 suggest that, even if more had been invested in evaluation, any further evidence would have been used to fuel argument rather than to resolve it.

It is therefore bold of the BBC to launch its three-part television series Safe with Us, designed to document the genesis, implementation, and impact of the NHS reforms. The series, to be screened over the next three weeks, illustrates both the strengths and weaknesses …