ABSTRACT
This chapter examines the story of the National Health Service (NHS) to the end of Tony Blair’s premiership, by which time the service was travelling in a new direction even though the final destination was yet to be reached. Successfully surviving the round of institutional reinvention was another regulator: the National Institute for Clinical Excellence, where the most obvious change was the addition of ‘Health’ to its designation and the creation of an advisory Citizens’ Council. The USA, Canada, Australia and the Netherlands were among the countries that had adopted payment by results: the ancestry of Healthcare Resource Groups can be traced back to the Diagnosis Related Groups first introduced in the USA. Negotiations were ostensibly conducted by the NHS Confederation, the NHS employers to whom the Department of Health had delegated responsibility for pay bargaining, but with close involvement by Ministers and officials.
