In November 1989, Kenneth Clarke, then Secretary of State for Health, published a White Paper, ‘Working for patients (NHS reforms)’, which proposed to introduce a split between purchasers and providers of care, GP-fundholders and a state-financed internal market, ‘in order to drive service efficiency’ in the National Health Service. Less than a year later, the creation of an ‘internal market’ in Britain’s largest public service had passed into law. A new public policy idea had been born, one that discarded previous economic orthodoxy about the fundamental difference between public and private sectors within a ‘mixed economy’.

Read the full chapter by Kathy for Kittens Are Evil: Little Heresies in Public Policy

This extract from Kittens Are Evil contains just Chapter 2: Public Service Markets Aren't Working for the Public Good... or as markets, by Kathy Evans, Chief Executive of Children England.

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