ABSTRACT
The author has offered an approach which starts with the insistence on patient-guaranteed care for all. If we want to run a system of controls from above, but do it more efficiently, this is as good an approach as the authors have seen. It is interested in 'the informed and trained user' to whom it offers more local activism, more politicised management for 'equality', fairness, redistribution of wealth, user 'consultation', user 'advocacy', citizens' juries, 'political restructuring' and local authority 'health scrutiny', patient surveys, 'needs-led' commissioning, and health authorities as 'champions of the people'. It remains to be seen whether at the next general election New Labour will line up on the side of the providers, and the Conservatives on the side of the patient/service user and the individual. As the author has outlined, this approach takes us further towards real change, but it still does not take direct incentives sufficiently seriously.
