ABSTRACT
The first paper (The reforms: success or failure or neither?) is an extract by Le Grand et al. taken from the conclusions drawn from a survey the authors undertook of the empirical evidence concerning the internal market introduced into the English National Health Service (NHS) in the 1990s. It uses policy analysis and economics to discuss whether the evidence indicates if the NHS internal market was a success or a failure. On the whole, it concludes that the internal market had little effect due to the weakness of the incentives and the strength of the constraints operating on both organisations and individuals. It then considers the lessons that can be learnt from the experiment. A key lesson is that it is unlikely that competition can be used as a major force for change inside the NHS. Finally it discusses if the lessons are apparent in the proposals for the internal market’s successor, as laid out in the Labour Government’s 1997 White Paper, The New NHS: Modern and Dependable.
