ABSTRACT

The UK National Health Service (NHS) offers a classic case study of the role of beliefs in institutional change. This chapter examines beliefs about institutional change in three periods: from the establishment of the NHS in 1948 until the first Thatcher government in 1979; from 1979 until the election of the first Blair government in 1997; and from 1997 onwards. In many respects the period 1948 to 1979 was one of institutional stability. The broad collectivist consensus spanned ten governments between 1948 and 1979, six Labour and four Conservative. It developed within, and was dependent on, post-war economic growth throughout the 1950s and early 1960s. During the period 1979-1989 the Thatcher governments concentrated on: improving management efficiency and accountability within the NHS; and encouraging private provision and private insurance. The social democratic version of the NHS has its roots in the beliefs of Old Labour's collectivism, universalism and redistribution, but these roots are increasingly slender.