Dalhousie Law Journal


National Health Service, NHS, reform, health care, Britain, policy, non-acute services, acute services, elderly, mentally ill, disabled, Patient's Charter, Cinderella, administrative law


This paper examines the impact of the NHS internal market reforms on an aspect of equity in the British system that features little in recent policy commentary: the allocation of resources between acute services for the entire population and nonacute services for the elderly, the mentally ill, and the disabled (the so-called "Cinderella" services). The authors' research on health planning and contracting in the NHS in Wales suggests that patterns of services have remained largely unchanged, and that pressures in the reformed system, such as the Patient's Charter initiative, prevent any major reallocation of resources away from the acute sector. Given the ineffectiveness of the contract mechanism in changing funding patterns, the authors consider whether the wider NHS reforms have nevertheless extended the legal remedies available to patients from the "Cinderella" groups faced with inadequate services. Recent cases suggest that, while the courts are reassessing the principles applied in reviewing administrative action affecting the allocation of health care resources, it is patients requiring acute care who are most likely to benefit. The authors conclude that, in terms of progress towards a more equitable distribution of resources between sectors, the NHS internal market is not a good model for other nations to emulate.