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

Document Type : Commentary


Department of Health Services Research, University of Liverpool, Liverpool, UK


This commentary explores some of the issues raised by Gilbert et al.short communication, Morality and Markets in the NHS. The increasing role of market mechanisms and the changing types of healthcare providers together with the use of choice and competition to drive improvements in quality in the National Health Service (NHS), all have important ethical implications. In order for the NHS to continue providing the level of service quality that out performs many high-income countries, despite spending much less on healthcare, we need a re-think of creeping marketization and privatisation and a consolidation of the NHS as a publically owned resource run for the benefit of patients and the public, not commercial interests.


Main Subjects

  1. Gilbert B, Clarke E, Leaver E. Morality and Markets in the NHS. Int J Health Policy Manag 2014; 3: 371-6. doi: 10.15171/ijhpm.2014.123
  2. Dopson S. Changing forms of managerialism in the NHS: hierarchies, markets and networks. In: Gabe J, Calnan M (eds). The new sociology of the health service. London: Routledge; 2009.
  3. Mohan J. Visions of privatization: new labour and the reconstruction of the NHS. In:  Gabe J, Calnan M (eds). The new sociology of the health service. London: Routledge; 2009.
  4. Whitfield D. A typology of privatisation and marketization. European Services Strategy Unit. 2006. Available from:    essu-research-paper-1/essu-research-paper-1-2.pdf
  5. NHS Confederation. Any qualified provider. Discussion paper, Issue 10, July 2011. Available from:
  6. Pollock A, Price D. Duty to care: In defence of universal health care. Policy Paper. Centre for Labour and Social Studies. 2013. [cited 28th January 2015].                _to_care_Allyson_Pollock__David_Price.pdf
  7. Hunter D. A response to Rudolf Klein: a battle may have been won but perhaps not the war. J Health Polit Policy Law 2013; 38: 871-7. doi: 10.1215/03616878-2210512
  8. Hawkes N. Why are the media so soft on Circle? BMJ 2012; 345: e5351.  doi: 10.1136/bmj.e5351
  9. Care Quality Commission (CQC). Chief Inspector of Hospitals recommends Hinchingbrooke Health Care NHS Trust is placed in special measures following Care Quality Commission inspection. 9 January, 2015. [cited 28th January 2015]. Available from:         -hinchingbrooke-health-care-nhs-trust-placed-special
  10. The Guardian. Circle in talks to exist private contract to run Hinchenbrooke Hosptial. 9th January 2015. Available from:         jan/09/circle-exit-private-contract-hinchingbrooke-nhs
  11. Department of Health. NHS Constitution. London: DH; 2009.
  12. Institute for Innovation and Improvement. Living our Local Values. NHS; 2008.
  13. National Health Service (NHS). Report on the Effect of the NHS Constitution.  London: Department of Health; 2012.
  14. Improving the allocation of health resources in England: How to decide who gets what. Kings Fund. 2013. Available from:             improving-the-allocation-of-health-resources-in-england-kingsfund-apr13.pdf
  15. Monitor. Procurement, patient choice and competition regulations: guidance. 2013. Available from:
  16. BMA Competition Law and the NHS. 2015. Available from:                reconfiguration-and-integration-new/competition-and-choice-new/choice-and-competition/section-75-briefing
  17. Donaldson C. Credit Crunch Healthcare. Bristol: Polity Press; 2011.
  18. BMA Lords debate on motion to annul Section 75 regulations. 24 April 2013. Available from: competition-and-choice-new/choice-and-competition/section-75-briefing
  19. Frith L.The NHS and Market Forces in Health Care: The need for organisational ethics. J Med Ethics 2013;39; 17-21. doi: 10.1136/medethics-2012-100713
  20. NHS Reinstatement Bill. Available from:
  21. Ingleby D, McKee M, Mladovsky P, Rechel B. How the NHS measures up to other health systems. BMJ 2012; 344: e1079. doi: 10.1136/bmj.e1079