Globalisation, Markets and Healthcare Policy by Tritter Jonathan;Koivusalo Meri;Ollila Eeva;Dorfman Paul;

Author:Tritter, Jonathan;Koivusalo, Meri;Ollila, Eeva;Dorfman, Paul;
Language: eng
Format: epub
Publisher: Taylor & Francis Group
Published: 2011-03-01T00:00:00+00:00

An unintended consequence of the adoption of this enhanced market-based system was the alteration of the relationship between healthcare professionals and patients. In this sense, decisions were to be driven by consumer demand, rather than provider judgement. Paradoxically, Working for Patients also centralised ministerial decision-making powers. Thus the new centralised objective setting and review mechanisms were in tension with the autonomy and accountability in the new trusts at the local level.

Working for Patients developed the theme of customer orientation in the context of consumer rights later rehearsed in the Patient’s Charter (Department of Health 1991). The twinned rhetorical policy imperatives of ‘choice’ and ‘voice’ were conjoined in order to ‘give patients, wherever they live in the UK, better healthcare and greater choice of the services available’ (Department of Health 1989: 3). The White Paper went on to stress that it was important to ‘make the Health Services more responsive to the needs of patients’ via the delegation of ‘as much power and responsibility as possible … to the local level’ (Department of Health 1989: 4).

On balance, the Patient’s Charter (Department of Health 1991) clearly defined patients as consumers and effectively embedded new public management within the NHS. But the Charter also recognised contrasting imperatives. As the Director of King’s Fund noted at the time,

[T]he patient’s charters recognise the importance of public services, a welcome change from the past decade. It also emphasises that the NHS belongs to the public, which has a right to know what to expect. Giving patients more power is not stated explicitly, but the charter should help to achieve this.

(Stocking 1991: 1148)

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