A new deal with the public

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Part of The public and the NHS

The 70th anniversary of the NHS is an opportunity to reflect on its enduring popularity and to revisit the implicit “deal” – what people can expect from the service and what their obligations are in return – between the public and the NHS.

In place of fear

Nye Bevan spoke of the sense of serenity that occurs when people are freed from the fear of having to pay for medical care. With patient charges comprising a tiny proportion of NHS funding and international surveys showing that the UK performs better than other countries in enabling people to access care without having to worry about paying, Bevan’s wish has been fulfilled. The founding deal assumed that patients should receive a standard response to their needs. Changing expectations and the rise of individualism have challenged this notion, and more attention has been given to treating each patient as a person with distinctive needs. Personal health budgets are one way of doing this and shared decision making between patients and clinicians is another.