BMJ editorial by Chris Ham about competition in the NHS. As he says, the question is whether competition is the right route to take for healthcare.
A "free service for all" was the defining principle of the NHS (Portillo, 1998). The subsequent introduction of prescription charges was intended to suppress unnecessary demand. One problem of the government's latest reforms will be how to control demand when patients have more choice. I suspect charges could well be introduced in the future for what is seen as treatment of a lesser priority. This will have moved us on from the defining principle of the NHS. Aneurin Bevan, minister of health in the Atlee government that introduced the NHS in 1946, resigned because of the introduction of prescription charges.
The NHS has also been a monopoly provider, which the government reforms are intended to challenge. The aim of the nationalisation of health services was to makes services more adequate, in terms of coverage and quality, and more rational, in terms of distribution of resources (Klein, 2006). Because of the kind of commodity health care is, the nationalised model may well fit it better than a free market model. Commercial dependence on the patient makes medicine less objective. Wasn't the NHS created to deal with exactly the muddle of healthcare that the current government's reforms could create?
Global critical psychiatry
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