The Troubled Transformation of Britain's National Health Service

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Abstract
If births can be difficult, so can rebirths. The creation of Britain's National Health Service (NHS) in 1948 provoked political friction and medical opposition. Its current transformation is also proving contentious. In the first few months of 2006, the word “crisis” and the NHS were reunited in newspaper headlines — a coupling familiar throughout the history of the service. NHS trade unions staged protests as staff were laid off; patients worried as media stories about hospitals delaying treatment or economizing on drugs multiplied; the chief executive of the NHS took early retirement; and the prime minister rushed to the defense of the government's policies. What made this spectacle both puzzling and revealing was the disjunction between cause and effect. The cause was a fiscal hiccup: a relatively trivial deficit in the NHS's accounts. The effect was political drama. Just when the government's radical plans for the NHS appeared to be heading toward success — with extra billions of funding flowing in, waiting times dropping, and quality improving — doubt, skepticism, and hostile criticism crept in. Was the prime minister right in claiming that the disruption caused by a fiscal hiccup was no more than a transitional blip, inevitable when carrying out an ambitious plan of reform? Alternatively, did it indicate weaknesses in the way the government had designed and implemented its policies? Was the government going too far too fast in reinventing the NHS?

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