The advent of the Labour Government in 1997 witnessed the end of ‘ managed competition’ and birth of ‘ modernizing agenda’ reform for NHS. Modernizing agenda was incorporated in the NHS Plan of 2000. This plan was the outcome of the administrative reforms introduced by the government through Public Service Agreements (PSAs). According to a Cabinet Office note, the functioning of all the public services in the UK is subject to their respective PSAs. They define the relationship between the government and its departments. Introduced in 1998, the PSA concept covered three vital areas viz. , modernization, accountability and reforms (Cabinet Office, UK, 1999).
PSAs are entered into between the departments and the ministries controlling them. Each PSA identifies aims and objectives, performance target and efficiency/value targets for the concerned departments. It is designed to integrate the overall objectives of the government and the department, in the context of improved services to the public and co-operation at the international level for sustainable economic growth. Towards this end, SMART (specific, measurable, achievable, relevant and timed) targets are agreed upon and monitored. Finally, since the services are to be rendered within the available resource, specific targets identifying value-for-money are set along with a mechanism for measuring the output against targets. This 10-year plan identified five key areas for implementation viz. , investments through greater public funding, ensuring quality standards, improving access to care services, promoting inter-professional working and integrating service provision, and providing more public health or ‘ whole-systems’ approach (Goodwin, 2002).
A key feature of this plan is while quality standards are imposed from above, sufficient freedom of action is left to the healthcare providers to innovate and improve services to achieve the set goals.
The greater the success, the greater will be the autonomy of actions (Dept. of Health, cited in Goodwin, 2002). Under the investment strategy, quantified areas of improvement in the number of beds, hospitals, equipment of different kinds critical to medical care, etc. have been spelled out.
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