BMJ 2008;336:805-807 (12 April), doi:10.1136/bmj.39532.445197.AD
Analysis
Competition and integration in the English National Health Service
Chris Ham, professor of health policy and management
1 University of Birmingham, Birmingham B15 2RT
doi: 10.1136/bmj.39524.400498.AD
Market based reforms of health care have helped cut waiting times, but Chris Ham argues that a different approach is needed to meet government objectives on disease prevention and chronic diseases
| The first 150 words of the full text of this article appear below. |
New healthcare objectives are often announced without changing the mechanisms used to implement them, leading to delays and frustration for policy makers. Gordon Brown and the ministerial team at the Department of Health face the challenge of avoiding this problem after the prime ministers first major speech on the NHS signalled that greater priority is to be given to disease prevention and the treatment of chronic diseases.1 What changes need to be made to the health reform programme to enable these priorities to be implemented?
One approach would be for the government to revert to the use of targets and top down performance management to achieve its objectives. Although there are some signs that the government may be moving in this direction—most obviously the instruction to the NHS to undertake a deep cleaning programme of hospitals—it seems unlikely that top down performance management will be the main means used to . . . [Full text of this article]

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