Let's return to representative planning for a population

doi:10.1136/bmj.39556.411100.80

BMJ 2008;336:905 (26 April), doi:10.1136/bmj.39556.411100.80

Letters

Competition in the English NHS

Let’s return to representative planning for a population

The first 150 words of the full text of this article appear below.

Ham has reached the conclusion that the market approach to healthcare is not appropriate for disease prevention and chronic disease,and he argues for integration in health care.¹ Most people workingin the NHS have thought that the so called market is inappropriatefor health care since it was introduced in the 1990s.² Competitionbetween health providers is espoused by politicians, journalists,and health economists as the best way to motivate people towork harder and improve efficiency. In fact, the market setsdifferent parts of the NHS against each other and leads to afragmented approach, rather than ensuring that all work togetherfor the welfare of patients. It sets primary care against secondarycare and both types of care against social services. Is thisgood care?

Ham points to weaknesses in commissioning. It is ridiculousto exclude secondary care specialists from this process. AsHam points out, . . . [Full text of this article]

Robert Elkeles, consultant physician and professor of diabetic medicine

¹ Imperial College Healthcare NHS Trust, St Mary’s Hospital, London W2 1NY

robert.elkeles@kelear.co.uk

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Rapid Responses:

Read all Rapid Responses

Patient and Public Involvement: John Gordon Gooderham
bmj.com, 25 Apr 2008 [Full text]
Planning, markets and wishful thinking: stephen black
bmj.com, 29 Apr 2008 [Full text]