A promising start, but fundamental reform is needed

This is the first of seven articles

The NHS has just received its largest sustained increase in resources since the service was started in 1948. To ensure that the money is spent wisely, Britain's prime minister has set about producing a national plan for health, with the help of six action teams—on prevention and inequalities, partnership, performance and productivity, the professions and the wider NHS workforce, patient care (empowerment), and patient care (speed of access). The BMJ has asked six commentators to state what their priorities would be in each of these areas, and we will be publishing these articles over the next few weeks. This week, however, we start with a commentary from Alain Enthoven, professor of public and private management at the graduate business school, Stanford University. Enthoven's ideas were a driving force behind the creation of the internal market in the NHS in the 1990s; he recently revisited the subject in last year's Rock Carling lecture, and we invited him to give his impressions on the prime minister's current plans for the NHS.

The prime minister was right to promise more money for the NHS. I recently wrote: “The NHS is obviously very short of resources needed to achieve its objectives. One sees it in the buildings, the pay, the staff and equipment shortages, the very short times doctors spend with patients, and the headlines about crises.” 1

The prime minister was also right to say “that the NHS needs fundamental reform if it is to provide the standard of care that people deserve in the 21st century.” 2 Money alone will not get us there.

And the prime minister was right to call attention to the wide variations in performance in the NHS. Among his many examples: “Why is there a twofold difference in the cost …