Back to the future in NHS reform

PURPOSE - In the mid 1990s the NHS ‘did’ competition, in the mid 2000s the NHS is ‘doing’ choice. This paper aims to cut through the rhetoric, highlight the differences and parallels between then and now and identify if these differences will have a different or the same impact on local services. DESIGN/METHODOLOGY/APPROACH – Following a review of literature from the 1990s, a qualitative research study is used to examine the impact of competition and markets in the 1990s. The discussion examines the implications of this study for current system reform. FINDINGS - Patient choice recreates many of the features of the internal market, but despite concerns at the time, the internal market did not have a significant impact on services. It is likely that patient choice will similarly have a limited impact. RESEARCH LIMITATIONS/IMPLICATIONS - The research is a case study confined to Day Surgery in one part of the North of England. ORIGINALITY/VALUE - The paper reminds academics and practitioners what happened last time the NHS attempted to introduce a market-based system.