Introduction

Two years ago, a review of health policy by the King’s Fund described the Blair government’s reform programme as ‘relentless, almost hyperactive intervention’ (Appleby and Coote, 2002, p 5). If anything, the pace of change has since increased. Despite the decentralisation agenda set out in the aftermath of the NHS Plan, the deluge of policy documents from the Department of Health has continued. So is this ‘more of the same’, or can significant changes in the direction of policy be detected?

It is possible to interpret the policies that have developed as having elements of both modernisation and marketisation. ‘Modernisation’ can be seen as an attempt to shift the political economy of the National Health Service from a centralised command and control model, with its associated corporate politics, towards the delivery of health services through a series of separate local, independently managed, components. The efficient and effective use of resources in this devolved NHS is to be achieved by, on the one hand, centralised controls that hold local providers accountable for achieving particular outcomes, and on the other, by the manipulation of both demand and supply side factors to alter the behaviour of those who consume and those who provide health care.

Underlying Labour’s policies is therefore a recognition of the power of ‘market’ forces. Politically, ‘modernisation’ is driven through enhancing and harnessing the powers of healthcare users as individuals wishing to access good quality health care, while at the same time curbing the potential monopoly powers of those who provide that healthcare through new employment contracts and changes in the division of healthcare tasks (DoH, 2000). Whether this more devolved arrangement can also achieve a delivery system that is equitable in terms of the distribution of resources and healthcare outcomes is more open to question and a matter of concern for many.

Within this general framework, this paper explores areas where significant changes have taken place. Given the breadth and depth of the health policy agenda, it would be foolish indeed to attempt to cover all issues (for further analysis see Baggott, 2004). Instead we shall focus on two aspects where the Blair government’s health policy seems to have shifted significantly compared with its early years in office.