ABSTRACT
This chapter highlights the evolutionary nature of the reforms and the increasing understanding that has been gained of their impact during the process of implementation. Independent studies of the impact of the reforms highlight the difficulty for researchers in evaluating the effects of the changes that have taken place. The reforms which stem from Working for Patients are quite unlike previous reorganizations of the National Health Service in that they are based on a document produced to a tight timetable and which bears all the hallmarks of a strategy only half thought through. The principal disadvantage of an emergent strategy has been a degree of ambiguity and inconsistency on the part of politicians responsible for the reforms. Striking the right balance between management and the market was crucial to the success of the reforms and yet, as part of the emergent strategy, it was an issue whose significance was only recognized during the course of implementation.
