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British Medical Bulletin Advance Access originally published online on May 26, 2007
British Medical Bulletin 2007 81-82(1):39-50; doi:10.1093/bmb/ldm013
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© The Author 2007. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

The new model NHS: performance, perceptions and expectations

Rudolf Klein*

London School of Economics, 12A Laurier Road, London NW5 1SG, UK

* Correspondence to: Rudolf Klein, London School of Economics, 12A Laurier Road, London NW5 1SG, UK. E-mail: rudolfklein30{at}aol.com

Objective: This article analyses the transformation of the National Health Service (NHS) in England from a command-and-control to a mimic market model.

Areas of agreement: Even while introducing market incentives and encouraging private providers, the new model preserves the essential characteristics of the NHS as a universal, tax-funded service free at the point of delivery.

Areas of controversy: The spectacle of famine among plenty—service cutbacks at a time when the level of spending on the NHS is at a rate unprecedented in its history—raises doubts about the competence of both local managers and central policy makers. Payment by results gives providers an incentive to maximize activity so prompting questions about the future rationing of resources and the role of the medical profession therein.

Areas to develop research: The implementation and effects of the policies already introduced and their modification in the light of experience.

Keywords: National Health Service • transformation • transitional strains • future challenges

Accepted for publication April 18, 2007.


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