ABSTRACT
Choice is seen as a catalyst, a source of energy, and of those reconnections denied by the centralised planning systems of the National Health Service (NHS) and by its denials of basic information and of choice to consumers. The crucial overall cultural choice is between dynamism and statism. The dynamism is represented by individual financial empowerment and the impact of economic incentives on cultures and performance. A key point on which consideration of Alan Milburn's ideas pivots concerns the position that culture can be changed only by changes in structures. Direct economic and moral incentives offer a social and moral theory which predicts that the structure of rewards can prompt new behaviours. They can help to achieve more efficient, different and individually effective outcomes. Advice, advocacy, counselling and user led support is important, too. These are elements which markets uniformly generate, and which the first introduction of direct payments prompted immediately.
