The changing face of the English National Health Service: new providers, markets and morality.

INTRODUCTION: One significant change in the English National Health Service (NHS) has been the introduction of market mechanisms. This review will explore the following questions: should we have markets in healthcare? What is the underlying philosophy of introducing more market mechanisms into the NHS? What are the effects of this and does it change the NHS beyond anything Bevan might have imagined in 1948? SOURCES OF DATA: The review will use empirical studies, philosophical literature, bioethics discussion, policy and NHS documents. AREAS OF AGREEMENT: The NHS is facing unprecedented challenges at the beginning of the 21st century, with funding levels not meeting the increase in demand. AREAS OF CONTROVERSY: The extent and appropriate role for market mechanisms in the NHS is hotly debated. It will be argued that we are moving towards a more market-based NHS and the possible effects of this will be discussed. GROWING POINTS: Rarely are the policy changes in the NHS evidence based in any meaningful way and they are often driven by ideological considerations rather than clear evidence. There needs to be a greater reliance on evidence of what works and a continuing commitment to healthcare as a societal good. AREAS TIMELY FOR DEVELOPING RESEARCH: There needs to be a discussion of what the NHS should be-a funder and provider, a funder or a partial funder? How the balance of power between regulators, different types of provider, commissioners and ultimately patients will play out in this changing environment are also areas for future study.