New labour and reform of the English NHS: user views and attitudes.
BACKGROUND
The British National Health Service has undergone significant restructuring in recent years. In England this has taken a distinctive direction where the New Labour Government has embraced and intensified the influence of market principles towards its vision of a 'modernized' NHS. This has entailed the introduction of competition and incentives for providers of NHS care and the expansion of choice for patients.


OBJECTIVE
To explore how users of the NHS perceive and respond to the market reforms being implemented within the NHS. In addition, to examine the normative values held by NHS users in relation to welfare provision in the UK.


METHODS
Qualitative interviews using a quota sample of 48 recent NHS users in South East England recruited from three local health economies.


RESULTS
Some NHS users are exhibiting an ambivalent or anxious response to aspects of market reform such as patient choice, the use of targets and markets and the increasing presence of the private sector within the state healthcare sector. This has resulted in a sense that current reforms, are distracting or preventing NHS staff from delivering quality of care and fail to embody the relationships of care that are felt to sustain the NHS as a progressive public institution.


CONCLUSIONS
The best way of delivering such values for patients is perceived to involve empowering frontline staffs who are deemed to embody the same values as service users, thus problematizing the current assumptions of reform frameworks that market-style incentives will necessarily gain public consent and support.
Wallace
Andrew
A
Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK. Andrew.wallace@lshtm.ac.uk
Taylor-Gooby
Peter
P
D001294:Attitude to Health; D004465:Economic Competition; D018166:Health Care Reform / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D057240:Patient Preference; D010816:Physician Incentive Plans / Q000458:organization & administration; D011057:Politics; D017149:Private Sector / Q000458:organization & administration; D013222:State Medicine / Q000191:economics / Q000458:organization & administration*; D006113:United Kingdom