Reform of the NHS is progressing rapidly, but it is difficult to discern a clear underlying theme or sense of direction of that reform. The Government has committed greatly increased funding to the NHS on the basis that it is accompanied by thorough modernisation and reform. If the aim is to improve the health and well-being of people in England, the health service needs to be designed in a way which is most likely to deliver this objective.
To date, it seems that the reforms embrace both a consumerist and a citizenship approach. The consumerist approach, making use of familiar tools and techniques of the market, has played an increasing part in public sector reform over recent decades, in an endeavour to improve efficiency. Such an approach in the long-term will not result in a system designed for the best interests of patients, nor will it be in the wider interests of communities.
This paper suggests that the citizenship approach is the more appropriate basis for reform of the NHS for the twenty-first century, and that it is more likely to provide a platform to change attitudes towards health issues, and encourage greater responsibility for personal health.