Intended for healthcare professionals


Can the government’s proposals for NHS reform be made to work?

BMJ 2011; 342 doi: (Published 31 March 2011) Cite this as: BMJ 2011;342:d2038
  1. Kieran Walshe, professor of health policy and management, 1,
  2. Chris Ham, chief executive2
  1. 1Manchester Business School, Manchester, M15 6PB, UK
  2. 2King’s Fund, London W1G 0AN, UK
  1. Correspondence to: K Walshe Kieran.walshe{at}

The new health bill is contentious, and growing professional opposition to some aspects could undermine the reforms. Kieran Walshe and Chris Ham suggest some changes that may help the government to make its reforms work

Since the publication of the coalition government’s white paper in July 2010,1 the political, professional, media, and public response to the proposed National Health Service reforms has shifted from incomprehension, through scepticism, towards increasing opposition.2 Many important stakeholders whose support will be essential, such as general practitioners, NHS managers, patient groups, and local authorities, do not accept the need for these reforms3 and fear their potential risks and costs for the NHS at a time of huge financial challenge.4 But preparations for their implementation have proceeded apace, in advance of legislation, and their reversal would now be very difficult.

The two main stated aims of the reforms—improving quality and outcomes for patients, and making health services more patient centred—unsurprisingly command universal support. So do some of the mechanisms for achieving those aims, such as greater localism—creating an NHS that is effectively managed and organised by and for the communities it serves, is responsive to the needs and concerns of patients both individually and collectively, and in which there is both less cause and less opportunity for the Department of Health to micromanage the NHS from a distance and to intervene with central directives. The emphasis on creating an NHS in which clinical professionals work collaboratively to provide consistently high quality, effective and efficient healthcare, and where clinicians take the lead in designing care pathways and take responsibility for the use of resources is also widely endorsed.

The main area of contention concerns the development of competition among providers, the increased role of the private sector, and the wider use of other …

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