New public management and the Thatcher healthcare legacy: enough of the theory, what about the implementation?

Initial evaluations of Thatcherism suggest that it represented a policy formulation success but implementation failure (Marsh and Rhodes 1992), with healthcare reforms particularly unsuccessful because they did not challenge the autonomy of the medical profession (Wistow 1992a and 1992b). More extensive analyses of the implementation of new public management (NPM) within health care take this challenge more seriously. According to Ferlie et al. (1996), doctors were gainers and losers, since the rise of the management function coincided with a rise in medical involvement in management decisions. However, this article argues that the rise of the purchasing function of health authorities undermined this 'gain' to the medical profession. Further, the significance of the case study—AIDS policy in Scotland—is that profound change has occurred in a policy area in which one would least expect this to happen.