Intended for healthcare professionals


A full blooded market system: at what cost to the NHS?

BMJ 2011; 343 doi: (Published 13 July 2011) Cite this as: BMJ 2011;343:d3238
  1. Ian Kirkpatrick, professor of work and organisation, Leeds University Business School,
  2. Christopher McCabe, professor in health economics, Leeds Institute of Health Sciences
  1. I.Kirkpatrick{at}

The current plans to reform the NHS have, with some justification, been described as the biggest shake up of the service since its creation. Abolishing primary care trusts and transferring responsibility for 65% of the budget to clinical commissioning groups (or so called senates) represents a bold move. Ultimately this promises to transform the architecture of the NHS into a more diverse and market based system. The move away from the standard state monopoly of the current NHS, it is claimed, will also deliver substantial cost savings, cut red tape, and empower clinicians (read doctors) to run the service. Over the next five years the changes are predicted to save £5.1bn (€5.7bn; $8.2bn), including £3.9bn from commissioning.1

Perhaps not surprisingly these claims are hotly contested. Critics point to the very substantial costs of transition and to massive disruption of services. The think tank Civitas, for example, predicts an absolute drop in performance of “quality of service” and “use of resources” lasting at least one year in primary care trusts that are merged.2 Following the so called listening exercise in April even the government now acknowledges that the original 2013 deadline for the completion of the reforms should be relaxed.3

Others have raised even more fundamental questions about the unintended consequences of an open market for health. Kieran Walshe, professor of health policy and management at Manchester Business School, described the reforms as “a huge distraction from the real mission of the …

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