In what sense a National Health Service?

Abstract

Under the recent Conservative and current Labour Governments it appears that the NHS is moving in two different directions at once. Some commentators claimed that the national character of the health service was undermined while others argued that the NHS was effectively nationalised. One reason for these apparently contradictory positions is that there are no clear criteria of what a National Health service is. This article presents three main characteristics of a national health system, with illustrations from the NHS. Recent events seem to confirm that the NHS has never been clearly a national or a local service, and existing trends seem to lead to the worst of all worlds: the disadvantages of central control, and local differentiation without any genuine local autonomy. As the NHS is arguably the most national service in the British welfare state, it is possible that the heyday of the national welfare state may be over.