Localism in the NHS quasi-market

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19 Citations (Scopus)


The organisation of the British National Health Service (NHS) has been hierarchical and based on defined geographical areas [for example, health authorities (HAs)]. These areas have formed the basis of local health systems in which the social relations between individuals and agencies were contained within the territorial boundaries of the respective organisation and thereby engendered, in most cases, a degree of trust and cooperation. The introduction of quasi-market mechanisms in the NHS in 1991 inferred that the social relations between local actors were not essential and hence transactions could be independent of them. Economic transactions need not therefore be confined to the local area. However, social relations have continued in various forms since the quasi-market was implemented as manifested through, inter alia, the persistence of localism in the market. Localism is evident, for example, in HA expenditure, which remains highly skewed towards local providers and, it is argued here, is a function of social relations between purchaser and providers. Localism and the social relations associated with it exemplify the relational nature of the quasi-market, which has shown signs of moves towards longer term contracts, risk-sharing and cooperation (rather than competition). Thus, by noting the persistence of localism and social relations, the author suggests that the quasi-market has yet to evince the paradigm shift intended by the 1991 reforms.

Original languageEnglish
Pages (from-to)449-462
Number of pages14
JournalEnvironment and Planning C: Government and Policy
Issue number4
Publication statusPublished - Aug 1998




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