Final Report > Chapter 4: The Changing NHS 1984 - 1995 > Nature of the change

Nature of the change

4 The fundamental political driving forces of the 1980s and 1990s were the desire to transform the economy to make it more efficient and competitive and to control (and if possible reduce) public spending. The NHS, as part of the public sector, attracted attention. But it attracted attention because it was part of the public sector, not in its own right. The changes introduced, therefore, were the application to the NHS of a more general set of ideas. They were not crafted exclusively with the specific needs of the NHS in mind. Moreover, the ideas of the day were concerned with efficiency, and with the market as the economic model for delivering it. These ideas appeared to many, both inside and outside the NHS, to constitute a challenge to the internal values of the NHS. A contrast was drawn between the values of community, of social justice and social welfare, of service and selflessness on the one hand, and, on the other, those of commerce, of output and throughput, of cost control and cost-efficiencies, of managerial rather than professional direction. Whether this contrast was caricature or reality was less important than the fact that this was how many perceived the changes in the NHS.