Improving NHS performance: human behaviour and health policy

Policies towards the NHS in the postwar period reveal a variety of assumptions on the part of politicians about the motivations of managers and clinicians. For much of this period, the NHS was a classic example of the centralised, bureaucratic organisation in which politicians at the apex sought to control the behaviour of staff at the periphery through a combination of central planning and national directives. The weaknesses of this command and control system led the Thatcher government to introduce radical reforms to the NHS in the 1990s. At the heart of the Thatcher reforms was devolution of control to NHS trusts and general practitioners and the use of competition to improve performance.

In turn the weaknesses of the market model have prompted the Labour government elected in 1997 to make still further reforms, trying to bridge the gap between centralised control and market mechanisms—the so called “third way.”