ABSTRACT
In this chapter, the author proposes a new and entrepreneurial structure which will align direct payments and incentives, focuses on outcomes which will be significantly defined by patients, and establishes a clear framework of services accountable to patients. He explores the important tension — and its implications for NHS reform — further in the chapter on 'needs' and 'wants'. Insofar as a new structure is proposed — and there can be no credibility in argument for change without at least a firm outline with which to begin the process of adjustment — this is intended to be so structured as to evolve and adapt in response to consumer wishes. It seeks recovery of willing collaboration, but with the role of the 'expert' advisory, not exemplary, and it offers the argument that, by willingly collaborating in mutual purchasing organisations, the individually empowered patient can benefit from capital itself and from the benefits it delivers.
