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Will a market deliver quality and efficiency in health care better than central planning ever could? No

BMJ 2010; 340 doi: (Published 10 March 2010) Cite this as: BMJ 2010;340:c1300
  1. Neal Lawson, chair
  1. 1Compass, London SE1 7SJ
  1. neal.lawson{at}

    James Gubb (doi:10.1136/bmj.c1297) and Stephen Smith (doi:10.1136/bmj.c1299) are convinced that market forces will improve the NHS, but Neal Lawson and Jonathon Tomlinson (doi:10.1136/bmj.c1302) have their doubts

    Markets or targets? That’s about as good as the choice gets for people working in the NHS. You—the doctor, nurse, secretary, cleaner, or manager—can’t be trusted to do your job properly without daily interference from the top or competition. There is no such thing as public service ethos, no calling, and no duty to the public to serve. There is certainly no ingenuity or ability to be innovative or make common sense decisions based on the evidence before your eyes, the experience you have gained, or the training you have gone through. Instead, you are either so stupid that you have to be …

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