BMJ  2008;336:805-807 (12 April), doi:10.1136/bmj.39532.445197.AD

Analysis

Competition and integration in the English National Health Service

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 minister’s 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?

Policy options

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]

Problems of practice based commissioning

Need for integration

How integration could work

Maintaining choice

Next steps

Summary points

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This article has been cited by other articles:

• Delamothe, T. (2008). A fairly happy birthday. BMJ 337: a524-a524 [Full text]  
• Bamji, A. N (2008). Current system has lost touch with reality of patient care. BMJ 336: 1088-1088 [Full text]  
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Rapid Responses:

Read all Rapid Responses

Competition and integration in English National Health Service

Robert S Elkeles
bmj.com, 15 Apr 2008 [Full text]

Collaboration rather than competition is the way forward

Rodney Burnham, et al.
bmj.com, 18 Apr 2008 [Full text]