Intended for healthcare professionals

Rapid response to:

Editor's Choice

Sleepwalking into the market

BMJ 2013; 346 doi: (Published 20 March 2013) Cite this as: BMJ 2013;346:f1850

Rapid Response:

Re: Sleepwalking into the market

Godlee and Reynolds are right to point out that the current changes to the NHS are the culmination of a process which began with the introduction of the "internal market". The belief that the NHS is best run as if it were a business has been endorsed by all subsequent governments, despite the lack of any convincing evidence to support it.

From this perspective, it is a logical step to move from a quasi-commercial system to a genuinely commercial one. The Government's intention is symbolised by the decision to rename the NHS Commissioning Board "NHS England", with the clear implication that the primary role of the NHS in England is no longer to treat patients but to buy services from the cheapest supplier.

These changes do not just threaten the fundamental basis of the NHS as a free public service, important though that is. The NHS, almost uniquely in the world, has the potential to provide integrated, planned healthcare for an entire population and to do so in a highly cost-effective way because it is not required to generate a profit or pay a dividend. Losing this will be a very high price to pay for irreversible, ideologicallly driven changes which are ultimately based on nothing more substantial than a naive analogy between delivering healthcare and running a supermarket.

Competing interests: No competing interests

27 April 2013
Anthony P Winston
Consultant Psychiatrist
Coventry and Warwickshire Partnesrhip Trust
Aspen Centre, Lakin Road, Warwick CV34 5BW