I wrote this book mainly to provide students of health and caring
sciences with a big picture of their work: how the National Health
Service (NHS) now functions in the society we have, and how it
might help to create a more civilised society in the future. Every
student needs such a big picture within which to work, and all of
them have such a picture – either the one passively accepted from
conventional assumptions, or one they build for themselves. Both the
conventional picture and apparent alternatives are now losing their
landmarks.1, 2 News of the reality of a health service driven ever faster
and at over 100% capacity toward constantly shifting management
targets, by forces apparently outside anyone’s control, is now reaching
even those just starting their professional careers. Twenty years ago,
virtually all students of health sciences expected to work their whole
lives in the NHS, in one or other specialist or generalist capacity
determined partly by their own interests, but mainly by patterns of
state investment directed toward perceived population needs. Today,
needs are increasingly assumed to be sufficiently represented by wants
– anything for which there is consumer demand, or for which such
demand may by media promotion be created. The health workers’
employer may now be either some NHS body fighting for economic
survival, or any corporate provider competing in the new public health
care market.