The NHS Company Inc.? The Social Consequence of the Professional Dominance in the National Health Service

The technology and organization of medicine has long outgrown its sociology with the result that physicians and medical care institutions have tended to become divorced from the actual needs and demands of most patients. The artificial maintenance of social polarization between patient and doctor and the preservation of an obsolete professional ideology have facilitated the development of trends in care better suited to those that control health care than those that use it. In recent years, the hegemony of the medical profession has been challenged by corporate and state interests as a more rational condominium has been sought for the pursuance of health care policy. However, there has been little or no attempt at an assessment of the actual health needs of the population. Implicit in the principles behind the inception of a National Health Service lay the promise that the history of health care would be determined by those it served. But failure to initiate an educational system representative and appreciative of the patients' milieu and to bring the control of health policy under the decisive influence of those who both work in and receive health care actually perpetuates and extends regional, sectional, and class distortions in the patterns and delivery of care.