Morality and Markets in the NHS

Document Type: Short Communication


1 Harvard University, Cambridge, MA, USA

2 Green Templeton College, University of Oxford, Oxford, UK


Since its establishment in 1948, the history of the National Health Service (NHS) has been characterized by organisational turbulence and system reform. At the same time, progress in science, medicine and technology throughout the western world have revolutionized the delivery of healthcare. The NHS has become a much loved, if much critiqued, national treasure. It is against this backdrop that the role of this state-funded health service has been brought into moral question. Certainly, the challenges facing healthcare policy-makers are numerous and complex, but in the wake of the Health and Social Care Act (2012), no issue is more divisive than that of market-based reform. Here we explore the turbulent history of the NHS, from its foundation to the birth of the healthcare marketplace. We explore arguments for and against the healthcare market and resolve that, amid an evolving economic and moral framework, the NHS must ensure that its original tenets of equity and autonomy remain at its core. We propose a values-explicit, systems-based approach to renew focus on both the processes and the outcomes of care.


Commentaries Published on this Paper

  • NHS Values, Compassion and Quality Indicators for Relationship Based Person-Centred Healthcare; Comment on “Morality and Markets in the NHS”

            Abstract | PDF

  • The Changing National Health Service: Market-Based Reform and Morality; Comment on “Morality and Markets in the NHS”

            Abstract | PDF

  • Morality and Values in Support of Universal Healthcare Must be Enshrined in Law; Comment on “Morality and Markets in the NHS”

            Abstract | PDF


Authors’ Response to the Commentaries 

  • Morality not Markets: A Manifesto for the NHS; Response to Pollock, Frith, and Cox

            Abstract | PDF


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