on the Centre for Welfare Reform website

NHS history Socialist Health Association

Principles for a National Health Service

One of the Centre’s friends, Jack Czauderna, recently shared this with us:

Dr Julian Tudor Hart, who has recently died, was a pioneering GP who inspired generations of health workers. He coined the term Inverse Care Law in 1971 which asserts:

“The availability of good medical care tends to vary inversely with the need of the population served. This inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced.”

Here are his 9 distinctive and essential characteristics of a National Health Service:

  1. A united national service devoted directly and indirectly to care, fully available to all citizens.
  2. A gift economy including everyone, funded by general taxation, of which the largest component is income tax.
  3. Its most important inputs and processes are personal interactions between lay and professional people.
  4. Its products are potentially measurable as health gains for the whole population.Its staff and component units are not expected to compete for market share but to co-operate to maximise useful service.
  5. Continuity of care is central to its efficiency and effectiveness.
  6. Its local staff and local populations believe they have moral ownership of and loyalty to neighbourhood NHS units.
  7. None of its decisions and few of its procedures can be fully standardised. All of its decisions entail some uncertainty and doubt. They are therefore unsuited to commodity form, either for personal sale or for long term contracts.
  8. The NHS is a labour-intensive economy. Every new diagnostic or therapeutic machine generates new needs for more skilled staff able to control and interpret the work of the machines and translate them into human terms.

We believe that this is from Tudor Hart’s The Political Economy of Health Care: A Clinical Perspective, published in 2006.

You can also read Tudor Hart’s Feasible Socialism online at the Socialist Health Association.

Principles for a National Health Service © Julian Tudor Hart