When politics and markets collide: reforming the English National Health Service

Reforms to the English national health service (NHS) are using patient choice and provider competition to drive improvements in performance. In completing the design of the reforms, the government faces the challenge of ensuring that commissioners can negotiate on equal terms with providers, and that appropriate arrangements are put in place for market management and regulation. Politicians also face the challenge of dealing with NHS providers that get into difficulty. The experience of implementing changes to the role of Kidderminster Hospital demonstrates the political risks involved in promoting reforms that affect the public’s access to valued services. With an increasing number of contested major service reconfigurations emerging, much hinges on the ability of the Independent Reconfiguration Panel to develop into a credible and respected source of advice to the government. If this challenge can be met, then the Panel may offer a way of reconciling the logic of a system driven by competition but overseen by politicians. When politics and markets collide: reforming the English National Health Service