Have new NHS market reforms learned from failings of old?

Abstract

The 1990 NHS and Community Care Act represented one of the most radical and significant reforms of the NHS since its creation in 1948. However, despite its high profile nature, which attracted worldwide attention, its attempt to introduce competition with the introduction of the internal market largely failed to deliver what had been hoped for.1–3 As such, upon their election in 1997, New Labour promptly announced the end of the ‘ill conceived’ internal market. In place of the competitive environment would instead be an emphasis upon co-operation.2 Despite this systematic change, more recent reforms sweeping through the NHS such as ‘patient choice’ and ‘payment by results’ appear to have resulted in a return to market mechanisms and the re-introduction of competition as a driver for improvement. This article will examine this apparent ‘u-turn’ and ask, have the new methods of introducing competition into the NHS learnt from the failings of old? This will be done by examining how and why the reforms failed to deliver what was expected. It will then go on to outline the current reforms/changes being introduced and seek to identify whether there are fundamental differences between new and old, and what (if anything) has been done to ensure that the causes of previous failures do not occur again this time around. In short, it will ask if the Labour government has learnt from the past.