Introduction

This chapter brings together the analysis from other chapters of this book to consider health policy since 1997, when Tony Blair's Labour government was elected. It takes the account of health policy and organisation through to the end of 2007, shortly after Blair retired as Prime Minister and Gordon Brown took over.

The context of health policy in 1997

During the 1997 election, Labour campaigned to ‘save the NHS’, but its approach to welfare policy during its first term in office faced a significant problem in that, in order to gain credibility with the financial markets, Chancellor Gordon Brown made it clear that he was going to honour Labour's commitment to keep within the public expenditure limits set by the previous Conservative government. This did not remove all possibility of change, but did mean that radical reform, which is not cheap, was unlikely.

The period from 1992 to 1997 marked a period where, after the confrontations between the doctors and the government over the policies in Working for Patients (Secretary of State for Health, 1989), health policy went through something of a ‘becalming’ (Wainwright, 1998). The internal market, radical in policy, turned out to be rather ‘bland’ in implementation (Klein, 1998) because the government retreated from its more radical promises, recasting the reforms as managerial rather than market-based (Ham, 2000) and so being more about contestability (the potential for competition) than competition (Sheldon, 1990).

Equally, it possibly became clearer to policy makers how little control they had in practice over the implementation of the internal market. With messages about attempting to assure a ‘smooth take-off ‘ for the new market coming from the Department of Health (Edwards and Fall, 2005, p 84), and with requests to minimise contract changes for the first year in order to minimise disruption, there was little incentive for district health authorities, the major purchasers of care, to try to contract with the best possible providers. After the first couple of years, contracting patterns seemed to change little in most areas, constrained by the combination of patients not wishing to travel too far for care and the lack of available local competition. Some commentators suggested that a market never existed in any recognisable form at all (West, 1998).