This paper is good but I think you downplay the ideology of Lansley´s approach. I don’t think this is just a managerial approach to solving problems -I think it is a political view that commissioning , under the auspices if Monitor to ensure competition is going to open up the private sector – because private sector per se is “good”. And is further down the road of the public sector just paying for services. I’m not arguing against the involvement of the private sector, just that I think that is the REASON for some of the changes.
There is also the issue of what problems all these changes are meant to address. Is it variation in outcomes, poorer outcomes than other countries (though I wonder how comprehensive the population is that is being covered in some of those international comparisons). Is it not enough “personalised ” care,rising costs so you need echanisms to reduce hospital admissions and reduce referrals to secondary care. Is it fear of political flack when things go wrong, therefore distancing the politicians from the NHS -(though I doubt that this will work , as the public will always blame the government when things go wrong). I’m not sure exactly what they are trying to put
right, in their terms.