ABSTRACT
This chapter provides an initial exploration of how the 1989 and 1997 legislation affected the belief and value structure underlying the pre-1989 National Health Service (NHS) and how it contributed to the erosion of trust in and within the health service. It outlines the concept of trust and reviews and comments upon economic, sociological and institutional approaches to trust. The chapter focuses on the impact of institutional change on three relationships: between purchasers and providers, between clinicians and patients, and between clinicians and NHS management. It describes and criticises different approaches to trust. The pre-1989 NHS operated on a basis of high value congruence. Given that the underlying value structure in the NHS was governed by the Hippocratic ethos, health care providers were viewed as sharing a common set of values based upon professional ethics and caring. The creation of an 'internal market' has led to some erosion of trust between the stakeholders of the NHS.
