New review of Labour's health reforms sounds warning for coalition government's agenda

A new book from The King's Fund, Understanding New Labour's market reforms of the English NHS provides the first comprehensive analysis of the impact of New Labour's introduction of competition to the NHS, offering key warnings for the coalition government's health reformers.

The authors argue that the coalition government's proposals for increasing competition in the NHS represent an evolution of New Labour's fledgling market-based reforms, but point out that Labour's reforms were implemented in a vastly different context.

  • The Labour reforms were introduced in a comparatively cash-rich financial climate. Increased funding and activity levels mitigated the effects of greater competition on NHS trusts. In the current climate, the pressures of competition may be felt much more acutely.
  • While the focus for the Labour government had been to increase access and reduce waiting times, the coalition government has recognised that the key challenge for the future NHS is to respond to an ageing population and to an increase in people living with long-term conditions. This requires a nuanced approach to extending competition. The authors argue that competition alone will be insufficient to meet these challenges and should be used alongside and in combination with increased integration within health care, and between health and social care.

While the authors found evidence that New Labour's market reforms had delivered some positive improvements to NHS services, the size of these effects were small. The reasons for this included the phasing in of different elements of market reforms across several years, a focus on provider reform rather than commissioning in the earlier years, and an often patchy implementation of market-based reform driven in part by resistance by NHS staff working on the ground.

Dr Anna Dixon, a co-editor of the book and Director of Policy at The King's Fund, said:

'The coalition government are proposing to implement a set of far-reaching reforms designed to strengthen the role of competition in the NHS. They would do well to learn the lessons from the experience of New Labour’s market reforms. While the context and priorities may have changed – with less money in the system and an urgent need to focus on improving care for those with long-term conditions – the evidence suggests the government should not put too much faith in competition as a driver of change.'

Order a copy of the book: Understanding New Labour's market reforms in the NHS

Notes to editors: 

For further information, or to request an interview, please contact the Press and Public Affairs team at The King's Fund on 020 7307 2585 (if calling out of hours, please ring 07584 146 035).

Understanding New Labour's market reforms in the NHS is a collection of edited chapters published on 23 Sept 2011 by The King's Fund. The book provides the first comprehensive analysis of the impact of the Labour government's market-led reforms of 1997-2010 and draws lessons for future reformers of the NHS in England. The book is embargoed for media until 00.01, 23 September 2011.

The book is available for £35, via 020 7307 2568 or on our website. The entire book, separated into chapters, will also be able to download free from The King's Fund website from 00.01 on 23 September 2011.

About the editors:

  • Anna Dixon is Director of Policy at The King's Fund.
  • Nicholas Mays is Professor of Health Policy at the London School of Hygiene & Tropical Medicine.
  • Lorelei Jones is a Research Fellow at the London School of Hygiene & Tropical Medicine.