Changing cultural visions in the NHS.
| Vision for the NHS, mid 1980s to mid 1990s (General Management and The Internal Market) | Vision for Labour's “New NHS”, late 1990s (The Third Way) | |
| Macro/system level factors | ||
| Basis of economic relationships: | Competition (contracts) | Cooperation/partnership (long term service agreements) |
| Governance: | Market discipline | “Third way” |
| Key objectives: | Efficiency | Efficiency/equity/quality |
| Rate of change: | “Big bang” | Evolutionary |
| Locus of change: | Top down | “Everyone's business” |
| Flows of information: | Confidential/commercially sensitive | Open/transparent |
| Basis of performance assessment: | Finance/activity/volume | “Balanced scorecard” |
| Micro/clinician level factors | ||
| Basis of practice: | Professional judgement | Evidence based |
| Basis of control: | Mutuality/trust | Audit, external verification |
| Clinical performance information: | Confidential | Publicly available |
| Participation in audit (e.g. confidential enquiries): | Discretionary | Mandatory |
| Accountability: | Largely opaque (professional self-regulation) | Transparent: corporate and clinical governance |
| Public confidence: | High | Diminished |
| Continuing professional development: | Discretionary | Mandatory |
| Ethical basis: | Hippocratic oath/patient first | Corporate objectives |