ABSTRACT
Successful reforms depend on direct incentives. If we wish to modernise the NHS and social care and to empower ‘choice’ and benefit from competition there are specific policy recommendations which could form a new framework. This chapter summarizes the policy recommendations. Choice would be choice by being backed in every individual case by money. It would be ineluctable, unavoidable and a permanent factor in a market. It would require both competing purchasers and competing providers to seek willing revenues from the actual users of services. Money would be mobile. The individual would express preferences both by joining a mutual, cooperative purchasing organisation (a PGCA) and by negotiating about specific service (and costs) with that organisation. Choice would not depend on a list of centrally directed priorities, which can be and, indeed, are being actively ignored by PCTs. Choice would be particular, specific, individual and powerful.
