Intended for healthcare professionals

Rapid response to:

Observations Body Politic

Lansley had no choice but to make a full frontal assault

BMJ 2011; 342 doi: (Published 24 January 2011) Cite this as: BMJ 2011;342:d470

Rapid Response:

Is the NHS Only a Means of Delivering Healthcare?

I disagree with Nigel Hawkes that the NHS ' only a means of
delivering healthcare...'.1 I find the underpinning principle of the NHS,
that the more fortunate (in terms of affluence and health) help those less
fortunate, an attractive one. This 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. To this extent, the NHS
helps to promote civic virtue and contributes to the values of British
society. I would argue that the NHS 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). Since inequality and social cohesion are important
determinants of health, the way we structure our healthcare is likely to
affect our health and wellbeing in ways independent of direct effects of
preventative and therapeutic interventions. In addition the values
inculcated by the NHS might spill over into other areas of British life.

I don't argue that the NHS does not need reform or that it should not
continually strive to improve quality and efficiency, rather that the
wider implications of any such reform must be considered i.e. the design
of our health care system contributes to the values and nature of our

1. Lansley had no choice but to make a full frontal assault. BMJ
2011; 342:d470

Competing interests: No competing interests

07 February 2011
Gareth Forbes
Leadgate Surgery