ABSTRACT
The British National Health Service (NHS) is an example of a universal and tax-based Beveridgean system, offered at the national level. Over the last 40 years, and particularly coinciding political devolution in the UK in the early 2000s, various policy reforms have changed service arrangements and administrative aspects of the system. This chapter focuses on NHS England, reviewing aspects of each reform during this period and highlighting the system’s gradual liberalization, which ultimately allowed the participation of private organizations to compete for program space and resources, while also influencing the NHS ethos through managerialism, competition, and results-based payments. The discussion concludes with the last decade, between the 2012 Health and Social Care Act and 2022 Health and Care Act, which offers a legal framework for already implemented internal changes that culminate with the establishment of an Integrated Care System (ICS). Influenced by American corporate insurance models, ICS is based on 42 local boards across England, responsible for sustaining the legacy and universal access of an internationally significant and influential healthcare service, despite a loose policy framework with low levels of accountability and unknown effects to the NHS’s longevity.
