The Politics of Modernization: Britain's National Health Service in the 1980s

The history of the British National Health Service (NHS) over the past decade demonstrates both institutional adaptation and insulation from more basic structural change. Reflecting international trends, the NHS has, on the one hand, recentralized decision making, adopted strong managerialist policies, accommodated a modicum of privatization, and stressed the client's role in some service choices. On the other hand, the government has skirted introducing unbridled competition into the health service. Assessment of a 1989 "Government Review" highlights the tensions the NHS faces between budgetary pressures and consumer demands, and between centralized controls and medical autonomy, among others.