Managed Mental Health Care in the UK

Abstract

If managed care is defined as a system which seeks to manage the quality, access, and cost of health care, then Britain’s National Health Service (NHS) has just celebrated 50 years of such a system. The establishment of the NHS in 1948 as a tax-funded, centrally-coordinated, universal health-care system gave enormous power to central government to control expenditure and, to a lesser extent, also to control access to care. Quality of care and the achievement of good patient outcomes have always been emphasized, but responsibility for their achievement and assurance has (largely) been left to individual clinicians and their professional bodies and not imposed from the center. The election of a new (Labour) government in 1997 heralded a number of changes, but also re-affirmed the national commitment to a publicly-funded health service. Mental health care was immediately made a particular target for government attention, and the subsequent policy pronouncements have put much greater emphasis on the promotion of quality and the achievement of better patient and caregiver outcomes.