A view on NHS reforms.

The current 'reforms' of the NHS arose from concern over the increasing costs of health care; mistrust of the profession, including medicine and nursing; a contrasting excessive trust in the virtues of a managerial and mercantile culture; and possibly a desire to divert criticisms away from central government down to local agencies. The shape of the reforms largely reflected expedients which had been tried in the USA, with apparent neglect of the evidence that the system there had produced exceptionally costly and inequitable health care. With no prior evaluation in this country, and against much professional advice, the reforms were pushed through, and have caused problems. Massive managerial costs stemming from the artificial market have diverted resources, and also attention, from the care of patients. Doctors and nurses have tried to limit the damage, but limitation has its limits. To re-convert health care from a business to a service require abandoning the 'market', with its purchaser-provider split, and its imposition of a costly contractual framework on transactions which are in their nature clinical, not commercial.