Introduction

In March 1988 the Prime Minister announced that there would be a fundamental review by ministers of the way in which the National Health Service was organised and financed. The Government's intentions were announced in January 1989. The main proposals as expressed in the NHS review White Paper ‘Working for Patients’ were:

1. – To make the Health Service more responsive to the needs of patients by devolving as much power and responsibility as possible to a local level.

2. – To establish independent self-governing hospital trusts that would operate within the framework of the NHS.

3. – To reimburse providers of health care according to the services they render rather than the population they serve. The money for health care should follow the patient.

4. – To increase consultant posts in order to reduce waiting lists and help cut long hours worked by some junior medical staff.

5. – To enable large general practices to become budget holders, with the responsibility of purchasing some elements of health care on behalf of their patients.

6. – To reduce the size of health authorities, and to reform them along business lines by the appointment of executives and non-executive directors.

7. – To audit more rigorously the performance of health services to ensure optimum quality and value for money.