However, in his second term Blair pursued measures to strengthen the internal market as part of his plan to "modernise" the NHS. Driving these reforms were a number of factors including the rising costs of medical technology and medicines, the desire to increase standards and "patient choice", an ageing population, and a desire to contain government expenditure.
Since the national health services in Wales, Scotland and Northern Ireland are not controlled by the UK government, these reforms have increased the differences between the national health services in different parts of the United Kingdom. Reforms included amongst other actions the laying down of detailed service standards, strict financial budgeting, revised job specifications, reintroduction of a modified form of fundholding — "practice-based commissioning", closure of surplus facilities and emphasis on rigorous clinical and corporate governance. In addition Modernising Medical Careers medical training had an unsuccessful restructuring which was so badly managed that the Secretary of State for Health was forced to apologise publicly.
It was then revised but its flawed implementation left the NHS with significant medical staffing problems. Some new services were developed to help manage demand, including NHS Direct. A new emphasis was given to staff reforms, with the Agenda for Change agreement providing harmonised pay and career progression. These changes gave rise to controversy within the medical professions, the media and the public. The Blair Government, whilst leaving services free at point of use, encouraged outsourcing of medical services and support to the private sector.
Under the Private Finance Initiative , an increasing number of hospitals were built or rebuilt by private sector consortia; hospitals may have both medical services such as independent sector treatment centre ISTC or "surgicentres" ,  and non-medical services such as catering provided under long-term contracts by the private sector. The first PFI hospitals contained some 28 per cent fewer beds than the ones they replaced. In , surgicentres treated around three per cent of NHS patients in England having routine surgery.
By this was expected to be around 10 per cent. As a corollary to these initiatives, the NHS was required to take on pro-active socially "directive" policies, for example, in respect of smoking and obesity.
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The NHS encountered significant problems with the information technology IT innovations accompanying the Blair reforms. This must be controlled and in the NPfIT model it is, sometimes too tightly to allow the best care to be delivered. One concern is that GPs and hospital doctors have given the project a lukewarm reception, citing a lack of consultation and complexity. The programme to computerise all NHS patient records is also experiencing great difficulties. Furthermore, there are unresolved financial and managerial issues on training NHS staff to introduce and maintain these systems once they are operative.
Hospital death rates reduced, especially in stroke. The return of a Conservative -led government in coincided with another deterioration in industrial relations. The introduction of further private sector involvement in the Health and Social Care Act provoked mass demonstrations led by health workers, and some NHS workers also participated in a national strike over pay restraint in In , doctors and MPs warned that the ongoing privatisation of certain NHS England cancer screening services would lead to patient harm. From Wikipedia, the free encyclopedia. England portal. Retrieved 20 May People's History of the NHS.
Cultural History of the NHS project. Peter Catterall ed. London: Macmillan.
The Development of the London Hospital System, 1823-1982 by Geoffrey Rivett (Hardback, 1986)
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Dow , D. Leitch and A. Doyle , Barry M. Fox , Daniel M. Hayes , Nick and Barry M. London : Bailliere, Tindall and Cox. Marmion , V. Prochaska , F. Smith , Timothy B. Cardiff : University of Wales Press , , pp. Wardley , Peter ed. Weindling , Paul ed. Zelizer , Viviana A. The Washington summit was useful to Lyndon B. Johnson mainly because it allowed him to impress upon the British the need for them to retain their traditional 'great power' role and also to allow him to bring the multilateral force MLF to a conclusion.
Harold Wilson accepted the American view that Britain should preserve its current position in defence, telling the Cabinet on 11 December that 'the most encouraging fact about the conference was America's emphasis on Britain's world wide role'. Johnson not only wanted Wilson to maintain Britain's defence commitments, but to extend them into South Vietnam.