Underlying trends in the health service: a master theory. (Personal View)

The National Health Service is clearly undergoing big changes. Examples include the development of an internal market with subcontracting of services, the purchaser and provider split, and fundholding practices; the establishment of a whole range of regulatory mechanisms such as audit and postgraduate education allowances; an increased direction of general practitioners' activities, particularly in the realm of health promotion; and a fondness for target setting as a mechanism for transforming the health of the nation. Some of these changes are welcomed by doctors, others have been resisted, but behind all the diversity of appearance lies a unity of purpose.

All these changes can be interpreted as specific manifestations of a general societal trend. The major underlying motivation may be characterised as cynicism. Cynicism, in this context, is the unmasking of highmindedness as being merely a disguised form of lowmindedness. Different groupings in society no longer trust each other, every profession or institution tends to see the others as being on the make. …