The National Health Service

Abstract

The establishment of a National Health Service (NHS) without service-user charges and with the twin goals of minimising inequalities in health and maximising access to health care is associated with the socialist aspirations of the immediate post-war Labour Government. However it has long been argued that a key motivating factor was the less ideological, more technical goal of an efficiently managed health care system (Eckstein, 1958). Although the terminology may have changed, there is therefore a consistency and continuity in debates concerning the management of health services in Britain. This chapter takes as its start-point the establishment of the NHS in 1948 and looks briefly at the development of administrative and clinical management within the service up to the Griffiths Report (DHSS, 1983). The impact of Griffiths is reviewed and assessed before turning to the major restructuring of the Service and the introduction of internai markets, following the NHS and Community Care Act 1990. We conclude with a discussion on the future of the service in the event of a possible change of government at the next général élection.