Intended for healthcare professionals

Views & Reviews

NHS “reform” in England: where is the public interest?

BMJ 2012; 344 doi: (Published 14 March 2012) Cite this as: BMJ 2012;344:e2014
  1. David J Hunter, professor of health policy and management1,
  2. Gareth H Williams, professor of sociology2
  1. 1School of Medicine and Health, Wolfson Research Institute, Durham University
  2. 2Cardiff Institute of Society and Health, School of Social Sciences, Cardiff University
  1. d.j.hunter{at}

If the main political conflict of the 20th century was about regulation and the role of the state, that of the 21st century is about deregulation and the role of the market.1 Whereas the welfare state embraced the role of government, the market state is sceptical of government and favours competition and choice. The debate over the fate of the NHS in England, triggered by the government’s determination to replace a largely publicly provided service with an increasingly privatised one driven by competition, is a microcosm of the wider conflict between the welfare state and the market state. What has been described as 30 years of “market triumphalism” has embedded the assumption that government is the problem and markets are the main instrument for achieving the common good.2

The secretary of state for health asserts that “individual creativity and innovation is best supported by competition” [which] “is a critical element of healthcare system reform.3 This shift from public to private provision lies at the heart of the Health and Social Care Bill which, though bloodied, remains unbowed as it drags its way through …

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