Education And Debate

A third way? England-yes; Scotland-maybe

BMJ 1998; 316 doi: (Published 17 January 1998) Cite this as: BMJ 1998;316:213
  1. Greg Parstona, chief,
  2. Laurie McMahona, executive director of professional practice
  1. aOffice for Public Management, London WC1X 8JT

    Much of the comment on the white paper so far has ignored general intention and focused on details of employment, cash flow, and management-or rather the lack of them. Little is being said about the government's bold attempt to construct “a third way” between old bureaucratic command and control systems and the fragmentation and distortions of the internal market. This new path will effectively result in the creation of nationalised health maintenance organisations, led by clinicians but focused on population health. Yet the most commentators seem to be preoccupied with questions about “How do they expect to…?” without much understanding of “Why?”

    The English health maintenance organisation idea makes a lot of sense; moreover, the lack of detail at this stage is a positive feature. If there is anything to be learnt from the past two decades it is that changing a complex organisation like the NHS is …

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