Equal Access to Health Care and the British National Health Service

Equal access to health care is a central objective of many health care systems, and is often seen as the founding principle of the British National Health Service. However, this paper argues that it can be seen as a piece of grand or flamboyant rhetoric of symbolic politics, representing a misreading, or at least an oversimplification, of history. It examines stated equity objectives in the NHS by placing them in the cells of an equity matrix. It is discovered that few NHS policies have aimed to achieve 'equal access to health care' in any meaningful sense. Policies in the 'old NHS' were largely concerned with equality of provision, with some later moves towards equal expenditure for equal need. The 'new NHS' of the New Labour government stress both fair access and a more ambitious aim of reducing the health gap. Moreover, this rhetorical emphasis has obscured wider issues, in that little attention has been paid to issues such as which variations are unacceptable, how much variation should be tolerated, and the potential trade-offs between concepts such as equity and efficiency.