This is the backdrop that leads up to the prevailing structure and operation of the NHS. In this context, it is an accurate assessment to state that the core values and principles adopted by the NHS leadership today is quite different from the stated founding values when it was first instituted in 1948. From being a totally public sector funded and managed enterprise, the NHS has today is integrated into the private capitalist economy. While this transition has made the NHS more efficient and streamlined, it has lost its humane and caring touch. When one studies the structure and funding of the NHS today, it is obvious that terms such as ‘partnership’, ‘private finance’ and ‘efficiency’ have come to replace erstwhile core values of ‘service’, ‘care’ and ‘compassion’ (Simmons, 2009). Both the Tory leadership under Margaret Thatcher and later the New Labour policies under Tony Blair have brought about a new feel and perspective to this important institution. But this transformation has not been an insulated process, for it is just one manifestation of a broader shift in domestic policy adopted by both the Tory and New Labour parties. This emphasis on ‘partnership’ and ‘private finance’ is furthered by parallel initiative pertaining to capital investment by state bodies in the UK. The existing channels of funding and the structure of the organization is very much a product of such initiatives as the Private Finance Initiative (PFI) and Public Private Partnerships (PPP). According to the UK Treasury (2000) PFI/PPP offers modern governance and modern procurement and has made the NHS a more efficient organization. Further,
“PPP involves the introduction of private sector ownership in state activities–ranging from partnership agreements to full transfer of assets–co-operation of private sector firms in ‘exploiting the commercial potential of government assets’ and the PFI. PFI refers to the contracting by state bodies with private sector firms or consortia for the construction and maintenance of capital assets. Examples of PFI include infrastructure projects, such as the projected extensions to the London underground and recent hospital and school building programs. PFI contracts can be characterized by the acronym DBOO–design, build, own, and operate. Private firms raise the necessary finance to construct the contracted capital project, retain possession of property rights to those assets on the completion of construction, and responsibility for maintaining those assets. This represents a more significant incursion by the private sector into those activities than occurred under the competitive tendering initiative of the 1980s, where many tendered services remained in-house.” (Simmons, 2009)
Even the funding of NHS has undergone remarkable change from the institution’s early days. The infusion of private funds has accelerated in the last decade, and since the inception of the New Labour government in the year 1997, 85 percent of major NHS capital projects have been funded through the PFI mechanism. This situation might distort the priorities of the NHS “towards large-scale ventures, such as the construction and maintenance of new acute hospitals, at the expense of smaller schemes in the primary and mental health sectors, since the latter may be less attractive to private financiers than the former” (Mcmaster, 2002). Clearly the combination of PPP/PFI and further reform to the structure and procedures of health care provision in the NHS would lead to significant change within the institution. This change is triggered in part by the greater prominence of health economics within the corpus of mainstream economic theory that also underpins the economics of the so-called ‘third way’”. (Mcmaster, 2002)
In the last twenty odd years, the NHS has also become a more equitable employer, in terms of hiring people from various nationalities and ethnic backgrounds, which should count as a big positive for the institution’s image. For example, in recent decades, skilled immigrant labour has become the backbone of the National Health Services organization. Each year, the number of skilled and experienced doctors, nurses and other specialist hospital staff that join the NHS and contribute to its success come from abroad. Although politicians of all parties claim the NHS to be a uniquely British institution, its persistent success is made possible by its multi-ethnic and multi-cultural staff members. Many of the émigré healthcare professionals that join the NHS eventually take British citizenship and eventually start to recognize themselves as British. To elaborate further, doctors from India constitute a major chunk of foreign nationals in NHS. And their growing presence in Britain has only enriched the existing traditions and introduced newer ones. Hence it is accurate to say that changes made to the immigration policy, especially under the Labour rule of last 13 years has only enhanced the multi-cultural and egalitarian image of the NHS, boosting its overall appeal. (Merali, 2006)