Review

Values and money

Hidden Assets: Values and decision making in the NHS
Edited by Bill New and Julia Neuberger
King’s Fund, 2002. £17.00

Is the NHS a church embodying, in Barbara Castle’s words, Good Samaritan principles or is it, more prosaically, a garage where customers expect an efficient repair or maintenance service, failing which the better-off ones will take their business elsewhere?

Hidden Assets looks at this and similar questions in 15 essays by British and American academics. The contributors explore how changes in society’s values are affecting the actions of health policy makers. In July 2001, then health secretary Alan Milburn declared in a speech to the NHS Confederation that there would be a new relationship with the private health sector. He stressed that NHS values were not the same as those of the private sector and the government would risk the health service’s ethos, values and principles at its peril.

His words prompted the King’s Fund to set up a series of seminars to examine just what these values are and what they mean to people today. The book brings together many of the issues arising from them.

One essay looks at the dilemmas for policy makers when faced with evidence-based research that may be unpopular with the public. To what extent can you promote something that a community may oppose irrationally or with prejudice?

Another examines in some depth the tensions between the values of professionals and managers in the NHS. We are told that managers felt empowered under the NHS internal market of the last Conservative government. Today, however, they feel frustrated and devalued as politicians interfere much more in the day-to-day running of the NHS.

The book is much concerned with the patient’s emerging role as the questioning consumer — who a generation ago might have trusted their doctor implicitly. The work of the National Institute for Clinical Excellence is discussed in the context of the hard choices it is bringing to the public arena. The trade-offs between equity and individual choice are considered, together with the need to ensure that the patient understands that decisions have been made fairly.

There is a chapter on multiculturalism in medicine that stresses how the values of non-Western traditions can contribute much to patient care in the NHS. (It reminds us that the first public hospital dispensing treatment freely at point of need was opened in Baghdad in 809 AD.)

Hidden Assets concludes with case studies from projects involving the King’s Fund and stresses the growing likelihood of public participation in heath decision making and the inevitable conflict. It is not the easiest book to read but is well worth the effort and may prove to be a useful reference tool. If the NHS is a garage then Hidden Assets may be the brochure you read before venturing into the showroom.