The impact of market-like arrangements on specialist services: a case study.

This article considers how specialist hospital services in the UK fared under Conservative health policy, with its emphasis on market-like arrangements, and what looks likely under the New Labour era, where new shibboleths (cooperation, quality, etc.) supposedly are in place. There appeared inherent in the Conservative health policy threats to specialist services from local competition, and purchaser agendas for local health needs of equity and prioritization. Moreover, small providers grappled with costs and the bureaucracy engendered by market-like arrangements and with their inability to make economies of scale. From the policy rhetoric since the New Labour election victory of May 1997, one might expect such specialist services to be 'coming in from the cold', but the reality seems quite different. In particular, this paper will outline the policy context for specialist providers for the period in the 1990s when the Conservative government undertook to reform the NHS. We also, through the Unit that is the subject of the case study, examine the actual effects of those reforms on this specialist service. Finally, we reflect further upon the resonances for specialist services in the New Labour era that can be gleaned from the case study.