The elusive NHS consumer: 1948 to the NHS Plan

Since the creation of the National Health Service in 1948, patients have never been fully-fledged consumers of healthcare; they have never held personal economic power with which to express their needs and preferences to service providers. Nonetheless, the history of the NHS has demonstrated an ever-increasing policy interest in the needs of individual patients and in the responsiveness of services to these needs. Following the collapse of the postwar consensus which gave birth to the welfare state, successive governments have pledged to give priority to consumer needs, but have struggled to realise this priority in practice.Professional and state paternalism in defining patient needs and choices have endured. current policy emphasis on 'patient and public involvement' and 'partnership working' sustains a top-down bureaucratic approach but tempers practice with input from all stakeholders in local health economies. There is much to do to make the culture of the NHS genuinely responsive to consumer needs.