MANAGING THE NEW NHS - BREATHING NEW LIFE INTO THE NHS REFORMS

The essence of the NHS reforms is that they bring market forces to bea r on organisations providing public services, while allowing those org anisations more freedom to respond in ways that will improve the effic iency, effectiveness, and appropriateness of their services. The new s tructural changes to the NHS-a leaner management executive and fewer, slimmer regions-could be used either to strengthen these features of t he reforms or to frustrate them by allowing ministers and top manageme nt to intervene even more at local level and ''overmanage'' the market . To ensure that the aims of the reforms are not frustrated ministers and the management executive must restrict themselves to laying down c lear strategies and then allow purchasers and providers to meet those strategies in their own ways. They also need to ensure that the whole NHS can learn and benefit from local experimentation and devise ways o f managing the crises that will inevitably arise; otherwise they might be tempted to become involved in managing the market at too local a l evel, and the NHS will suffer the worst of both worlds: stifling burea ucracy at the top and parochial self interest locally.