Commissioning specialist services in the NHSBMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7119.1323 (Published 22 November 1997) Cite this as: BMJ 1997;315:1323
A national clearing house could pave the way
- Nick Black, Professor of health services researcha
- a Health Services Research Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT
A white paper is expected in the next few weeks which will set out the UK government's vision for the NHS—possibly the most important document for the service since Working for Patients in 1989.1 The government faces the tricky task of coming up with a formula which recognises the potential benefits of a purchaser-provider split—greater accountability and responsiveness to local needs—without the competition, fragmentation, and transaction costs of an internal market. The role of district health authorities and their performance since 1991 will be central in their considerations. Much attention has recently been paid to health authorities' capacity to commission specialised services, such as those for haemophilia2 and cochlear implants,3 which account for about £1.4bn (6%) of NHS expenditure. Before 1991 these services were funded centrally and managed at a regional level. Since then responsibility has largely been devolved to districts. Yet despite some transitional arrangements to ensure continuity, specialist providers have felt increasingly vulnerable. Is such concern justified?