Choice & Contestability
The concept of patient choice remains problematic because of the difficulty which the average patient has in understanding the risks associated with medical procedures. In different countries, this problem is addressed in different ways. In those countries where the state is dominant in the provision of healthcare, there have been attempts to introduce quasi-markets. The most common approach, developed by the Health Maintenance Organisations in the United States, is variously known as 'diagnosis-related group reimbursements', 'case-mix funding' (Australia) and 'payment by results' (UK).
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Accountability in the NHS: Implications of the government's reform programme (Web Page) Jo Maybin, Rachael Addicott, Anna Dixon, John Storey, 2011 King's Fund
This report examines accountability relationships in the NHS and analyses how these will change under proposed Conservative government reforms.
UKPatient Choice: How patients choose and how providers respond (PDF) Anna Dixon, Ruth Robertson, John Appleby, Peter Burge, Nancy Devlin, Helen Magee, 2010 King's Fund
This is a collaborative report written in partnership with RAND Europe, Picker Institute Europe and the Office of Health Economics. It considers how free choice of provider is operating in practice and what impact patient choice is having on hospital providers.
UKRefusing Treatment (PDF) Laura Brereton and James Gubb, 2010 Civitas This report concludes that patients are being denied potentially better, more timely treatment because of an NHS culture that demands loyalty to the family of NHS hospital providers. Based on a one-year study into the relationships between acute trusts and their commissioners, it concludes that existing NHS providers use their "muscle and connections" to keep providing services even when faster, higher quality care is on offer elsewhere. UK
Harnessing the Benefits of the Independent Sector: Priorities for the next government (PDF) NHS Partners Network, 2010 A briefing paper which sets out the argument in favour of choice between healthcare providers and how competition and the independent sector can be harnessed to improve quality and patient satisfaction. UK
Commissioning (PDF) House of Commons Health Select Committee, 2010 A review of the impact of the purchaser/provider split in healthcare commissioning in England 20 years after its introduction. UK
Fewer Hospitals, More Competition (PDF) Professor Nick Bosanquet, Thomas Cawston, Andrew Haldenby, Dr Patrick Nolan, Nick Seddon, 2010 Reform A report arguing that the NHS ought to be subject to spending reductions - and that the closure of hospital services, in most cases due to a redesign of service provision, will be one of the best ways to achieve this. UK
Co-operation and Competition Panel: Progress Report (PDF) Co-operation and Competition Panel, 2010 Deprtment of Health This progress report provides an update on the activities of the Co-operation and Competition Panel (established by the Government in January 2009). It recounts findings and lessons to help NHS organisations and others plan how to operate within the Department of Health's competition framework. UK
Management Practices in the NHS (PDF) Bloom, Nick; Propper, Carol; Seller, Stephan and Van Reenen, John, 2010 Centre for Economic Performance, London School of Economics This summarises a study of clinicians and hospital managers exploring how well NHS hospitals are managed and how this management can be improved - with particular awareness of the impact of competition between hospitals. A key finding is that competition stimulates better management and higher productivity. UK
Public and Private Hospitals Research Report (PDF) Productivity Commission, 2009 Australian Government This study examines the relative performance of public and private hospitals and rates of informed financial consent and out-of-pocket expenses for privately insured patients in public and private hospitals. UK
Choice at the Point of Referral: Early results of a patient survey (PDF) Robertson, Ruth and Dixon, Anna, 2009 The King's Fund This report summarises survey findings of patient experience of referral and hospital choice following a policy change three years previously. UK
Patient Power (PDF) Thomson, Ben and Mawdsley, Geoff, 2009 Reform Scotland A report which puts forward reforms for greater patient choice in Scotland's health services based on analysis of European systems of social insurance. UK
A Healthy Choice: Building a Stronger NHS (PDF) CBI, 2008 A report on improving the quality and efficiency of the NHS through patient-focused reforms. It suggests that commissioners must become the key players in promoting innovation, choice and faster access to healthcare through fair market managment. ISBN 978-0-85201-685-5 UK
Is the Treatment Working? Progress with the NHS System Reform Programme (PDF) Healthcare Commission & Audit Commission, 2008 An assessment of the major NHS reforms since 2000. The report looks at the impact of Payment by Results, patient choice, practice-based commissioning, foundation trusts, Independent Sector Treatment Centres and workforce contractual changes. UK
Private Spending on Healthcare (PDF)
Farrington-Douglas, Joe; Castro Coelho, Miguel, 2008
Institute for Public Policy Research (IPPR)
This report examines the role of private spending in health and finds that the private sector plays a valuable role in the sector in the UK. However, it argues that costs from the public purse to the private individual - e.g. by greater use of co-payments and top-ups or incentivising private insurance - will not increase NHS efficiency. Instead public funding increases for the NHS must continue increasing to meet demand for higher service standards. The full implications for organisation of supply are not clear.
Delivering Some of the Best Health in Europe: Outcomes not Targets (PDF) Conservative Party Policy Green Paper, 2008 This paper proposes the replacement of top-down, process driven targets with a new accountability mechanism that promotes patient choice based on publcily available information on local health outcomes. UK
Independent Sector Treatment Centres: Evidence So Far (PDF)
Pollock, Allyson M and Godden, Sylvia, 2008
A paper assessing the evidence on ISTC performance in the first two waves of the programme. It found that due to a lack of data collected or provided by the Department of Health it was not possible to determine any changes in value for money or quality of care.
UK
ISTCs and the NHS: Sticking Plaster or Real Reform? (PDF)
Confederation of British Industry, 2008
This report examines the record of Independent Sector Treatment Centres (ISTCs), the elective and diagnostic care units encouraged by the UK government. It finds that ISTCs are an NHS success story and that changing NHS behaviour and expanding patient choice will bring further benefits.
Just What The Patient Ordered: Better GP Services (PDF) Confederation of British Industry (CBI), 2007 This report calls for an overhaul of the existing provision of GP services, and for new providers to be introduced to the marketplace where this would serve patients' interests. It argues that making it easier to change GP; more flexible, patient-friendly opening and appointment times; the option to register at more than one practice; and greater use of walk-in centres and over-the-counter pharmacy advice would help break the link between where people live and their access to timely health care. UK
Windmill 2007: The Future of Health Care Reforms in England (PDF)
Harvey, Sarah; Liddell, Alasdair; McMahon, Laurie, 2007
King's Fund
Independent Sector Treatment Centres: A Review of the Quality of Care (PDF) Health Commission, 2007 This review examines the quality of services provided in ISTCs and reports that patients surveyed rated services highly. However, it warns that there are too many gaps in the data to consistently compare the quality of care in ISTCs with that of the NHS. The review also recommends ways of improving relations between the NHS and ISTCs, as well as addressing concerns about staffing, regulatory and contractual arrangements. UK
The NHS: The Next Ten Years (PDF) Hewitt, Patricia , 2007 London School of Economics (LSE) In this lecture the then Secretary of State for Health reflects on the achievements and failures during New Labour's ten years of investment and reform in the health service. It sets out how, over the coming decade, the NHS ought to "rise to the challenge of delivering the best health and healthcare for patients, and the best value for money for taxpayers". UK
Choice and Equity: PCT Survey (PDF)
Thorlby, Ruth and Turner, Paul, 2007
King's Fund
This report presents the findings of a King's Fund survey of action taken by PCTs to ensure equity of choice in service consumption. It finds that while there are examples of good practice, such examples are in the minority. It concludes that it is too early to tell whether patient choice will deliver fairer outcomes for patients, but that indications thus far suggest establishing equality of opportunity is already proving challenging for the NHS.
UK
An Anatomy of GP Referral Decisions (PDF)
Rosen, Rebecca; Florin, Dominique; Hutt, Ruth, 2007
King's Fund
This paper presents the results of a qualitative study investigating GPs' views about their role in supporting patient choice at the point of referral. It focuses on the level of support for patient choice, the information that GPs need to inform patients about choice and the impact of patient characteristics on equity in choice. It finds that there is broad support for more choice, but barriers to this ambition are identified.
Is the Treatment Working? Progress with the NHS System Reform Programme (PDF) Healthcare Commission & Audit Commission, 2008 An assessment of the major NHS reforms since 2000. The report looks at the impact of Payment by Results, patient choice, practice-based commissioning, foundation trusts, Independent Sector Treatment Centres and workforce contractual changes. UK
The Provision of Out-of-Hours Care in England (PDF)
Public Accounts Committee (PAC), 2007
The Stationery Office
This report examines the impact of the Government policy to raise standards in out-of-hours care by allowing GPs an opt-out and placing responsibility for this care with the local Primary Care Trust. While services have begun to improve, the report is scathing in its verdict on the preparation, performance and costs resulting from the policy shift.
The Provision of Out-of-Hours Care in England (PDF) National Audit Office (NAO), 2006 The Stationery Office This report examines the Department for Health's progress in providing high-quality out-of-hours services. In particular it looks at the effect of General Medical Services contracts, which allowed GPs to opt out of the responsibility of organising out-of-hours care entirely from 1 April 2004. It finds that there is considerable room for improvement but that services are getting better. This report was followed by the PAC report of the same name, which is also available on the Resource Centre. HC 1041 UK
Buying the Best for the NHS: Ensuring Smarter Capital Procurement (PDF) Confederation of British Industry (CBI), 2006 This CBI report uses five case studies of large-scale capital and service projects to highlight good practice in health service procurement. It provides a number of action points aimed at improving procurement by minimising costs without cutting quality. ISBN: 0-85201-625-5 UK
Registering Choice: How Primary Care Should Change to Meet Patient Needs (Web Page)
Corrigan, Paul, 2006
Social Market Foundation (SMF)
This report argues that choice in primary health care services has been realised far more in theory than in practice. The author considers which health service reforms the Government should be considering in order to address this problem, highlighting encouragement of user-centred primary care fit for diverse healthcare needs and lifestyle choices. The full report can be downloaded via this web page link.
ISBN 1-904899-36-6
UK
How to Regulate Health Care in England? (PDF)
Lewis, Richard; Alvarez-Rosete, Arturo; Mays, Nicholas, 2007
King's Fund
A fundamental issue in health care in developed nations is regulation: how far should the state retain control of services and how far ought provision be left to the market? This report compares levels on health-care regulation across four systems - the Autonomous Community of Catalonia, Germany, the Netherlands and New Zealand - with a view to drawing out lessons for the future regulation of the NHS in England.
Designing a New NHS: Ideas to Make a Supply Market in Health Care Work (PDF)
Timmins, Nicholas (ed) , 2006
King's Fund
This report is based on discussions by a King's Fund independent working group on the involvement of independent and voluntary providers to enrich quality and choice in health services. It does not question the desirability of marketised health service provision but merely observes that this is the policy of both major political parties in the UK. As such it examines the extent and functioning of such marketised provision, drawing recommendations both for central government and individual providers.
Where the Patient was King? A Study of Patient Choice and its Effect on Five Specialist HIV Units in London (PDF)
Thorlby, Ruth, 2006
King's Fund
In HIV and AIDS treatment, patient choice is an established policy norm. This report explores the impact of patient choice on such services through interviews with staff and patients from five HIV/AIDS units in London. Patient choice is found to have impacted on market-design but, although most patients value their right to choose, few exercise that right.
New Business Structures in Health and Social Care: Implications for Commmissioning and Commissioners (PDF) The Moore Adamson Craig Partnership LLP, 2006 A briefing paper that discusses the implications of commissioning helath and social care services from a wider range of new providers. UK
Our Health, Our Care, Our Say: A New Direction for Community Services (PDF) Department of Health, 2006 The Stationery Office This Government White Paper aspires to set a new direction for health and social health care. It sets four main goals - (i) better prevention services with earlier intervention, (ii) more choice and a louder consumer voice, (iii) tackling inequalities and community issues, and (iv) more support for people with long-term needs - as well as setting out the means for addressing these goals. ISBN: 0101673728 UK
Limits of the Market, Constraints of the State: the Public Good and the NHS (PDF)
Reid, John, 2005
Social Market Foundation (SMF)
In this publication the then Secretary of State for Health sets out the case for extending patient choice within the NHS. The essay seeks to tackle two objections to choice in health services: the belief that choice is a value only for those on the political Right; and the idea that choice is only meaningful where consumers' private money is brought to bear. It argues that choice empowers individual patients irrespective of their personal wealth and promises responsive, higher quality services for all users. The full report can be downloaded via this web page link.
ISBN 1-904899-20-x
UK
Supporting Choice (Web Page)
Wood, Claudia (Ed.), 2005
Social Market Foundation (SMF)
This publication presents arguments from a SMF a seminar on the promotion of choice in health services for those with special needs or limited capabilities. Speakers from the Department of Health, the NHS, academia and the Disability Rights Commission concur that user-choice is particularly important for vulnerable groups in promoting their independence and recognising their right to manage their own condition or disability. This link provides contact details for further information.
UK
The Future of Primary Care: Meeting the Challenges of the new NHS Market (PDF)
Lewis, Richard, and Dixon, Jennifer, 2005
King's Fund
This paper examines the potential impact of new competition policies in primary care. It outlines some of the main challenges facing the sector amidst a revolution in the provision of these services and suggests a number of possible ways for these market developments to advance further.
Public Views on Choices in Health and Health Care: A Qualitative Study (PDF)
Rosen, Rebecca; Curry, Natasha; Florin, Dominique, 2005
King's Fund
The King's Fund in 2005 held ten focus groups across England, Scotland and Wales to explore public views about choice in health and health care. This paper presents the findings of these investigations, with particular focus on the views of those with a long-term condition. Findings are presented around five key health market themes - (i) general attitudes to choice, (ii) recent experience of choice, (iii) future choice, (iv) professional support and information for choice, (v) choices about long-term conditions - and concludes with a discussion about the implications for future Government policy.
Understanding Public Services and Care Markets (PDF)
Netten, Ann; Darton, Robin; Davey, Vanessa; Kendall, Jeremy; Knapp, Martin; Williams, Jacquetta; Fernández, José Luis; Forder Julien, 2005
King's Fund
This paper examines key factors in the mixed-provision model used in care services. It examines how markets for home care, care homes and extra care housing work; how the market performs as a whole; and how policy and practice might be developed in the future.
Regulating Health Care: The Way Forward (PDF)
Dixon, Jennifer, 2005
King's Fund
This paper explores marketisation's impact on the NHS's regulatory regime. It stresses the need to clarify the roles of governmental and independent regulators and argues that economic regulation needs to resemble more closely that in the private sector, particularly with regard to improvement of performance.
Will More Choice Improve Outcomes in Education and Healthcare? The Evidence from Economic Research (PDF)
Burgess, Simon, Propper, Carol and Wilson, Deborah, 2005
Centre for Market and Public Organisation (CMPO)
Extending Choice in Health Care: Implications of the Economic Evidence (PDF) Carol Propper, Deborah Wilson and Simon Burgess, 2005 Centre for Market and Public Organisation (CMPO) This CMPO review considers several interlocking aspects of choice policy in health care: competition between hospitals, the responsiveness of patients to greater choice, the provision of information and the use of fixed prices. The paper concludes that there is neither strong theoretical nor empirical support for competition, but that there are cases where competition has improved outcomes. The paper ends with a discussion of the implications of this literature for the NHS. UK
NHS Market Futures: Exploring the Impact of Health Service Market Reforms (PDF) Lewis, Richard and Dixon, Jennifer, 2005 King's Fund This report analyses the UK Government's market reforms in the health sector, considering whether recent developments are capable of fulfilling the NHS's core aims, as well as examining the challenges reforms present, and exploring options for addressing those challenges. ISBN: 1 85717 534 4 UK
Choice and Contestability in Primary Care
Maclean, Niall, 2005
Social Market Foundation (SMF)
This paper examines the case for introducing certain kinds of choice into the primary care sector of the NHS. It describes the evolution of the current Primary Care Trust (PCT) structure and theoretical reasoning for how choice could improve quality and lower cost. It also presents the case for allowing GP's practices to choose the PCT to which they wish to belong, explains how this system could operate in practice and considers its limitations. The full report can be downloaded via this web page link.
ISBN: 1-904899-21-8
UK
A Good Choice for Mental Health (Web Page)
Rankin, Jennifer, 2005
Institute for Public Policy Research (IPPR)
This report argues that extending patient choice in the mental health sector would yield significant improvements not only in services, but also through challenging wider social issues such as stereotypes about mental health patients. The paper is available for free via the above link.
A Mature Policy on Choice (PDF)
Rankin, Jennifer, 2005
Institute for Public Policy Research (IPPR)
This report argues that extending older people's choice in care services would yield significant improvements not only in services, but also through challenging wider social issues such as stereotypes about ageing. The paper is available for free via the above link.
Health Reform in England: Update and Next Steps (PDF) Department of Health, 2005 The Stationary Office This document describes a single framework for reform of the NHS. It explains how the reforms will work, whilst also identifying areas where more work is needed to develop policy. The document also looks at the benefits of the reforms from the perspective of the patient. 272364 UK
Road Map to Reform: Health (PDF)
Goldsmith, Michael, and Gladstone, David, 2005
Adam Smith Institute (ASI)
This report is the second in the ASI's 'Road Map to Reform' series seeking to promote a new strategy for diversity and competition across government and public services. The authors argue that the best of the NHS can be retained under public-private co-operation, espousing a new model which will unleash innovation and enterprise in healthcare provision.
Mapping Choice in the NHS: Analysis of Routine Data (PDF)
Damiani, Mike, Dixon, Jennifer, and Propper, Carol, 2004
Centre for Market and Public Organisation (CMPO)
Policies in the National Health Service in England seek to extend the choice of provider of care for patients on waiting lists for elective surgery. This CMPO report tries to identify where in the country there are likely to be most constraints on choice for patients waiting over 6 months for elective care.
Choice: The Evidence (PDF)
Williams, Jonathan and Rossiter, Ann (Eds), 2004
Social Market Foundation (SMF)
This report provides an evidence-based analysis of choice policies in health and education. It presents research findings from a range of studies on the impact of choice, and draws conclusions about their further introduction in the UK. In particular it examines how well user-choice has been implemented, how well it has worked and the benefits and disadvantages it has delivered in the UK, Sweden, the US, Chile and New Zealand. It also identifies the conditions under which user-choice policies have flourished. The full report can be downloaded via this web page link.
Public-Private Partnerships in the National Health Service: Private Finance Initiative Good Practice Overview (PDF)
NHS Executive, 2004
This guidance note provides practical advice for NHS bodies involved in, or contemplating, PFI schemes. It is therefore intended predominantly for NHS Trusts, commissioning Health Authorities (HAs) and Primary Care Groups (PCGs). It comes in two parts: the first explains the nature and structure of the guidance, the second summarises use of PFI in the NHS.
Can Market Forces Be Used For Good? (PDF) Dixon, Jennifer; Le Grand, Julian; Smith, Peter, 2003 King's Fund This paper asks whether a highly centralised healthcare system can sit comfortably alongside a market-led approach, and whether market forces can respond effectively to meet the demands of the UK's ageing population. It is comprised of the views of three experts: Le Grand writes on stronger market incentives for secondary care providers; Smith argues against even modest experimentation with stronger market incentives; and Dixon looks at the plausibility of combining the best aspects of market disciplines with planned provision. ISBN 1 85717 477 1 UK
Reconciling Equity and Choice? Foundation Hospitals and the future of the NHS (PDF)
Mohan, John, 2003
Catalyst
This working paper argues that recent politically-motivated NHS reform has the potential to undermine an efficient, integrated and equitable health service. In defending the case for improving standards throughout the NHS rather than rival providers, however, the author fails to address how the fundamental issue of scarcity might be addressed within this framework.
What is the Real Cost of More Patient Choice? (PDF)
Appleby, John; Harrison, Anthony; Devlin, Nancy, 2003
King's Fund
This paper aims to set out the questions that the UK government must answer if it wants to place patient choice at the heart of a publicly-funded health care system. Such questions include how extra costs will be met, whether patients are willing and able to exercise choice in their own best interests, and what kinds of limits to choice might be needed.
Good Practice Guide: Learning Lessons from Post-project Evaluation (PDF)
Department of Health, 2002
The guidance offered in this note is intended to complement 'Public-Private Partnerships in the National Health Service: Private Finance Initiative Good Practice Overview'. Through improving project evaluation, the report aims to improve health providers' performance and ensure best value for public money.
The Role of the Private Sector in the NHS (Web Page) House of Commons Health Select Committee, 2002 The Stationery Office This report seeks to examine recent changes and trends in the relationships between private and independent service-providers, and the NHS. In particular it considers the NHS Concordat with the Private and Voluntary Sectors, the Private Finance Initiative and Public Private Partnerships. HC 308 UK
Getting Back Your Health (PDF)
Booth, Philip, 2002
Adam Smith Institute (ASI)
This report argues that people in good health should be able to get part of their taxes back and take the money to a private health insurer or company health plan. This would give patients better choice, driving down costs and driving up quality as new healthcare providers bid for their custom.
NHS Reform: Towards Consenus (PDF)
Browne, Anthony and Young, Matthew, 2002
Adam Smith Institute (ASI)
This report calls for an end to centralised health provision, to be replaced by a competing European-style social insurance. Under these proposals the government neither provides nor finances health but merely regulates. Hospitals and doctors are made fully independent as local trusts; families would subscribe to one of a number of social insurers, who would then buy the services from one of the independent providers.
Public Services and the Private Sector: A response to the IPPR (PDF)
Pollock, Allyson; Shaoul, Jean; Rowland, David; Player, Stewart, 2001
Catalyst
The Commission on Public Private Partnerships, conducted over two years by the Institute for Public Policy Research (IPPR), was set up "to introduce greater clarity to partnership arrangements" between the public and private sectors and "to produce a set of authoritative guidelines which will inform the use of partnership in the future". This response argues that the Commission failed to ask more fundamental questions about the role of markets and for-profit operators in the delivery of health care, education, long-term care and other public services.
Delivering the NHS Plan Department of Health , 2002 The Stationary Office This document provides information on the progress the Government has made so far in implementing the ideas in the NHS Plan for investment and reform. It also looks at the next steps which need to be taken to sustain progress of successful reform in the NHS. Cm 5503 UK
The Changing Public-Private Mix in Health Care Hunter, David and Robinson, Ray , 2002 This article examines the developments that have led to a change in the relationship between the public and private sectors in healthcare. Findings from the article show that the public-private mix in health care is changing, with the private sector becoming more likely to play an increasingly larger role in the future of the NHS. UK
The New Shape of Public Services Volume I: Health and Education (PDF)
Butler, Eamonn and Pirie, Madsen, 2001
Adam Smith Institute (ASI)
This report outlines a new vision for the NHS and state education, aiming to make both markets more innovative and consumer-focused. "Free-standing, self-owned and independent" providers would manage their own budgets and set their own policy and priorities. Driven by the demands of their customers, public services would utilise this autonomy to improve quality and efficiency.
The NHS Plan Department of Health, 2000 The Stationary Office This document from the Department of Health outlines the Government's radical plans for investment and a sustained increase in the funding for the NHS. It sets out the steps needed to transform health services so that it is redesigned around the needs of patients. The document also emphasises that a closer working relationship between the NHS and the private sector will be mutually beneficial. Cm 4818-I UK
A Successful NHS (PDF) Bosanquet, Nick, 1999 Adam Smith Institute (ASI) This report argues that the NHS must change its goals and make greater use of the private sector as a supplier of health services. The monopolisation of funding and decision-making within the public sector has contributed to inefficiencies within the NHS, which should therefore enter into a range of partnerships and agreements to commission services from private and voluntary providers. 1-902737-04-0 UK
Acute Health Services Under Casemix: A Case of Mixed Priorities (Web Page)
Auditor General, 1998
Auditor General, Victoria
This report audits one of the earliest public hospital systems to move to case-mix funding. It assesses at a macro-level management of certain acute health services, covering issues such as quality of care, access to acute health services and efficiency gains.
Department of Veteran's Affairs: Use of Private Hospitals
Australian National Audit Office, 1997
Report No. 28, 1996-1997
In Australia the Repatriation Commission provides medical treatment for veterans and others eligible due to war service and related circumstances. This report examines the use of private hospitals on behalf of the Repatriation Commission with a view to improving the consistency and quality of care available to veterans through private sector contractors.
Managing Better Health (PDF)
Goldsmith, Michael and Pirie, Madsen, 1988
Adam Smith Institute (ASI)
This report attempts to draw out the lessons from managed healthcare systems in use in the USA with a view to application in Britain. It suggests that a restructured management system with greater emphasis on choice and incentives would bring significant improvements for the NHS.
The Health Alternatives (PDF)
Pirie, Madsen and Butler, Eamonn, 1988
Adam Smith Institute (ASI)
This ASI report considers potential improvements to management of the NHS. It suggests evolutionary rather than revolutionary reform, to be achieved through the judicious use of competition, choice and incentive. The authors argue their reforms can improve the efficiency with which healthcare is delivered while safeguarding the NHS's major achievements.
Contracting-Out in Health and Local Authorities: Prospects, Progress and Pitfalls
Hartley, Keith and Huby, Meg , 1985
Public Money, pp.23-26
This paper presents the findings of a survey of 213 local authorities and district health authorities, examining the lessons, achievements and future targets of contracting out in the sector.