Is choice working for patients in the English NHS?

doi:10.1136/bmj.a935

Published 8 August 2008, doi:10.1136/bmj.a935
Cite this as: BMJ 2008;337:a935

Editorials

Is choice working for patients in the English NHS?

Auditors identify difficulties with the programme of systemreform

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

A recent report from the Audit Commission and the HealthcareCommission, Is the Treatment Working?, examines the successof the government’s programme for system reform of theNHS in England, promulgated in 2000 and 2002.¹ ² ³ The report,which includes evaluation of four important innovations—thecreation of foundation trusts, greater NHS use of the independentsector, provision of more choice for patients, and payment byresults—finds little hard evidence of benefits.

In most developed countries, healthcare systems have three maingoals—to control total costs, to achieve equity in accessby need, and to achieve excellence in performance (short waitingtimes, satisfied patients, and good outcomes).The economic logicis that—to achieve these three goals—we need threeeconomic instruments. Since 1976, the NHS has successfully controlledcosts with a cash limited budget and sought equity by distributingfunds to populations in relation to their needs. The problemhas been with improving the . . . [Full text of this article]

Gwyn Bevan, professor of management science

¹ Department of Management, London School of Economics and Political Science, London WC2A 2AE

R.G.Bevan@lse.ac.uk

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