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To expand on a point in yesterdays thread. The NHS has had many approaches to change At some point this can require a new structure. The history is:
1974 Hierarchy and consensus
1983 Introducing managerialism
1989 Quasi-markets with clinical involvement in commissioning
1974 Hierarchy and consensus
1983 Introducing managerialism
1989 Quasi-markets with clinical involvement in commissioning
1997 Hierarchy, regulation and performance management
2000-10 Money, markets, more performance management, improvement methods, provider autonomy. payment model reform, clinical commissioning and more regulation
2012 Different type of market
2014 Integration and planning
2000-10 Money, markets, more performance management, improvement methods, provider autonomy. payment model reform, clinical commissioning and more regulation
2012 Different type of market
2014 Integration and planning
All of these can be seen as attempts to extend management disciplines into clinical domains. to exert political control over things electorally salient issues and sate the Treasury desire to extract 'efficiency' (see where that got us)
An approach that allowed different mechanisms to create change that can be contained in a more flexible structure with less central control over the 'how' change is done would help a lot.
