From consumerism to partnerships. Britain’s National Health Service at the turn of the century

It has been argued that “consumerism ” has been one of the main influences on health policy in many countries over the last decade or so. This article focuses on the role of consumerism in U.K. health policy during this period through the introduction of changes in National Health Service provision such as introduction of the quasi-market, creation of the new managerialism, and new organizational structures set up under the recent Labour government. It considers the consequences of these changes for the users of health care and for citizenship rights, in particular the extent to which the changes have empowered these users and citizens. One theme of health care reform throughout Europe and North America for more than a decade has been the need to take into account the views of citizens and users when considering the provision of health care (1, 2). This position has been endorsed by the World Health Organization (3) and legislated in some states in the United States, where physicians are required to inform patients of treatment options so that they can make informed decisions about their care. In the United Kingdom, a major theme running through recent government policy on the National Health Service (NHS) and other areas of welfare such as social care has been an emphasis on taking into account the needs of users, the demands of consumers, or the rights of citizens. This had led some com-mentators (4) to argue that “consumerism ” appears to have become one of the main influences on health policy. Certainly, there are those who argue that emphasis on the user has been imposed on the government by the emergence of the so-called “consumer ” movement, which developed first in North America and more recently in Britain, under the auspices of the Consumers ’ Association and health-related pressure groups (5). From this perspective, the rise of the enlight-ened consumer indicates that knowledge is no longer in the hands of elite exper