Hostname: page-component-848d4c4894-8bljj Total loading time: 0 Render date: 2024-06-28T14:35:04.135Z Has data issue: false hasContentIssue false
  • English
  • Français

Visible hand or invisible fist?: the new market and choice in the English NHS

Published online by Cambridge University Press:  24 August 2007

CALUM PATON
CALUM PATON*
Affiliation:
Professor of Health Policy and Director, Centre for Health Planning and Management, UK
*
*Correspondence to: Calum Paton, Professor of Health Policy and Director, Centre for Health Planning and Management, University of Keele, UK. Email: c.paton@keele.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract:

As England (unlike the rest of the UK) retreads the market route in health policy, it is worth asking two questions. Firstly, is the government right that the ‘new market’ (as it refuses to call it, except in private seminars) is fundamentally different from the 1990s’ internal market which New Labour allegedly abolished in 1997? Secondly, given that the new market is clearly not characterized by the invisible hand, should we characterize it as steered ‘economically’ by a visible (facilitating) hand, on the one hand, or managed ‘politically’ by a fist which would like to remain invisible in order to maintain its power? This article goes on to examine choice in the new NHS with reference to Hirschman (1970), arguing that genuflections to the latter by pro-choice advocates such as Le Grand (2003) are just that – genuflections. Hirschman is used as a taxi by which to reach a desired destination rather than a stimulus to critical reflection, Hirschman-style, upon how ‘exit’, ‘voice’, and particular combinations of ‘exit’ and ‘voice’ may produce perverse outcomes.

Type
Debate
Information
Health Economics, Policy and Law , Volume 2 , Issue 3 , July 2007 , pp. 317 - 325
Copyright
Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Part of this original article was adapted and used, with the permission of this journal and its publishers, for a small part of Chapter 7 of the book, Calum Paton (2006) New Labour's State of Health: Political Economy, Public Policy and the NHS. Aldershot: Ashgate.

References

Department of Health (2005), Commissioning a Patient-Led NHS, London: Department of Health (July) (The ‘Crisp Letter’).Google Scholar
Hirschman, A. O. (1970), Exit, Voice and Loyalty: Responses to Decline in Firms, Organizations and States, Cambridge, MA: Harvard University Press.Google Scholar
Le Grand, J. (2003), Motivation, Agency and Public Policy: of Knights and Knaves, Pawns and Queens, Oxford: Oxford University Press.CrossRefGoogle Scholar
Paton, C. R. (1995), ‘Present dangers and future threats: some perverse incentives in the NHS reforms’, British Medical Journal, 310(1):1245–1248.CrossRefGoogle ScholarPubMed
Paton, C. R. (2005), ‘The state of the healthcare system’, in Sausman, C. and Dawson, S. (eds), Future Health Organizations and Systems, Basingstoke: Palgrave.Google Scholar
Paton, C. R., with Hunt, K., Birch, K., and Jordan, K. (1998), Competition and Planning in the NHS: The Consequences of the Reforms, Cheltenham: Stanley Thornes.Google Scholar
Propper, C., Burgess, S., and Green, K. (2004), ‘Does competition between hospitals improve the quality of care? Hospital death rates and the NHS internal market’, Journal of Public Economics, 88(7–8): 1247–1282.CrossRefGoogle Scholar
Stevens, S (2005), ‘View from the bridge – steering the NHS’, Keele University, Centre for Health Planning and Management Annual Alumni Association Lecture (October 21).Google Scholar