Intended for healthcare professionals

Views & Reviews Review

How Labour changed the NHS

BMJ 2011; 343 doi: (Published 30 November 2011) Cite this as: BMJ 2011;343:d7786
  1. David J Hunter, professor of health policy and management, School of Medicine and Health, Durham University
  1. d.j.hunter{at}

What can we learn from New Labour’s pro-market reorganisations of the NHS? It’s not clear that more competition and choice were responsible for any gains made, says David J Hunter, and what was the cost of their implementation?

Learning lessons from policy changes is desirable even if, as in the case of this book which charts New Labour’s English NHS market reforms, it may seem too late to inform the next wave of change. This assumes, of course, that policy makers want to learn lessons. They can be fussy, selective consumers of evidence, cherry picking that which supports their preferences while ignoring inconvenient truths.

In a democracy perhaps this is how it should be because—as the research here shows—evidence is rarely sufficiently robust or uncontested to stand alone as a guide to action. Not that a casual reader would reach this conclusion from Julian Le Grand’s unashamedly smug foreword. Le Grand, a key architect of the NHS reconfigurations when he was adviser to Prime Minister Tony Blair, derives immense, misplaced satisfaction from being proved right about the changes …

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