Politics and procedures: the strategy process in a health commission

One of the objectives for the NHS and Community Care Act, 1990 was that health care services in future would be tied more closely to local needs. Unfettered by historic patterns of resource allocation, which reflected senior consultants' preferences in both clinical practice and committee, the new purchaser/provider split was to enable a changed approach to health service development. One group of major purchasers of health care, the health commissions, are required to research the health needs of the local population and to determine appropriate and possibly radical service models in a manner which is at once both scientifically rational and politically sensitive. A study undertaken in a health commission over a 16-month period analysed this process in two purchasing strategies.