Lessons from the past decade for future health reforms

BMJ 2009; 339 doi: (Published 29 October 2009) Cite this as: BMJ 2009;339:b4372
  1. Chris Ham, professor of health policy and management
  1. 1Health Services Management Centre, University of Birmingham, Birmingham B15 2RT
  1. c.j.ham{at}

    The continual change imposed on the English NHS has caused many staff to feel disillusioned. Chris Ham looks at what the experience can teach those planning further reform

    The National Health Service in England has been on a rollercoaster ride of reform for over a decade. The journey started in 1997 with the white paper, The New NHS, and continued through the introduction of performance targets and standards. New systems for inspection and regulation were then introduced, followed by reforms to increase patient choice and competition. The most recent changes focus on quality and safety with improvement being led locally by clinicians (box).1 2 3 4 5 6 With a general election expected in 2010, and the opinion polls indicating the likelihood of a change of government, further reform seems inevitable. I have identified 10 lessons for policy makers from the experience of the past decade.

    NHS reforms 1997-2008

    • 1997: The New NHS—Announced a third way of reform based on partnership and driven by performance

    • 2000: The NHS plan—Introduced large numbers of performance targets and standards with annual assessment of NHS organisations and publication of results2

    • 2002: Delivering the NHS planIncreased choice for patients, and providers have to compete for patients3

    • 2004: The NHS improvement plan—Placed greater emphasis on needs of people with chronic diseases4

    • 2008: NHS next stage review— Emphasised need to focus on the quality and safety of health care with change being led locally with the full engagement of clinicians5

    Policy making in opposition is often weak

    When I make presentations about the NHS reforms to managers and clinicians, one of the first questions I am asked is, did the Blair government have a master plan for the NHS when it was elected? The answer of course is no.

    When it was elected the Blair government …

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