Treatment According to Need: Justice and the British National Health Service

Abstract

Abstract The British National Health Service (NHS) was founded in July 1948 on the basis of three principles: universality, comprehensiveness, and free access (Webster, 1998, p. 22). That is, it was to provide health care to all, regardless of age, class, sex, religion, or geography; the care it provided was to be complete, rather than, for example, only a basic package of care; and there was to be no cost to the patient for the treatment provided. These three principals were seen as expressions of the more fundamental principle that treatment should be supplied according to need (and not, say, according to ability to pay). At first, it was thought that the NHS might be so beneficial to the country’s economy that it would constitute an overall saving, and that it would be little used once the population had been raised to a certain level of health. Almost immediately these hopes proved ill founded. In the first nine months of the NHS’s existence, real cost outran the estimated amount of just under £200 million by over £75 million (Ross, 1952, p. 15). Not only had demand been underestimated, but also the potential for development in medical science. Over the next few decades, scientists made huge advances, offering treatments hitherto unavailable, which were often of great benefit to the patient while of great cost to the NHS budget. It soon became clear that, though formally each individual might be entitled to make a demand on the NHS, the principle of free access had to be limited. To restrict usage, prescription costs and other charges were introduced. And in more recent times, the principle of comprehensiveness also has been explicitly constrained. In 1991, for example, the North East Thames health region stated that patients would not be treated for certain conditions, including the removal of nonmalignant lumps (Ham, 1992, pp. 244-5).