Intended for healthcare professionals


Universal health coverage in the UK

BMJ 2019; 367 doi: (Published 31 December 2019) Cite this as: BMJ 2019;367:l7054

Linked Opinion

Run the NHS, but do not call the UK your home

  1. Lucinda Hiam, GP champion1,
  2. Miriam Orcutt, senior research fellow2,
  3. Robert Yates, political health economist3
  1. 1Doctors of the World UK, London, UK
  2. 2Institute for Global Health, University College London, London, UK
  3. 3London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to:

The fundamental principles of the NHS are under threat

The UK’s national health service was founded on the principles of treatment based on need regardless of ability to pay. As an early example of universal health coverage, it has often been looked to by countries seeking to emulate it. At home, it is seen as something that captures the national identity, as was apparent in its prominence in the opening ceremony of the 2012 London Olympics. However, changes implemented by the governments in power since 2010 threaten to undermine its fundamental principles,1 and especially that of universal access to healthcare.

Hostile environment

The “hostile environment,” first championed by Theresa May as home secretary, has pervaded many sectors that have essential roles in promoting health, such as housing and education, but its effect is particularly stark in healthcare. Primary care remains free, but secondary and community care—including services such as termination of pregnancy, palliative care, and mental health—are charged upfront for patients who cannot prove entitlement, with those unable to pay being refused care.2 …

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