Abstract :
Some time around 2001, new Labour crossed an ideological rubicon by accepting
that provider competition and patient choice were valuable to prod the
National Health Service (NHS) towards better performance. Exactly what produced
this ideological volte face by the then Secretary of State, Alan Milburn
(and presumably some time earlier by the Prime Minister), has never been
made clear. It may have been as simple as the fact that all other levers had
been tried to reduce waiting times for elective treatments without enough effect.
Or that extra supply of beds and staff were needed overnight to make progress,
and the only source of these was outside of the NHS. Most likely it was both
reasons. But no dressing up the need for extra supply or the desire to give
more patients choice could hide the raw verdict that competition for resources
between institutions – external threat – was a helpful motivator for the staff
within them, including even the holiest of men and women in the NHS, the
clinical staff. In making this verdict, new Labour had accepted what had been
concluded by the Conservatives over ten years previously, which culminated
in the policy of the White Paper, Working for Patients, in 1990, and the implementation
of the NHS internal market in 1991.
