Abstract

We describe the founding aspects of the English National Health Service (NHS), which have characterised its activities and orientations that allowed it to achieve, over the years, significant results in terms of improving health outcomes, fighting inequalities, and guaranteeing equity of access. Particular attention is given to the historical and cultural evolutions that have given rise to problems and critical issues, and that today risk undermining its universalism, as is happening in Italy and other countries with a public health service. The article offers some reflections on the growing expansion of the private sector alongside an institution (the NHS) that guarantees appropriateness and sobriety, and is free from interests other than that of achieving the best possible level of health for individuals and communities. Empirical observations are already beginning to show the negative repercussions on health outcomes and the protection of the most fragile individuals, where the guarantee of public governance is eroded over time by alleged economic unsustainability