The development of minimally invasive therapy in the United Kingdom

The diffusion of minimally invasive therapy (MIT) must be understood against the background of sweeping changes in the organisation and funding of the National Health Service (NHS) in the UK. The separation of purchasers from providers of health care makes national policy, in theory, less important, as local developments are supposed to drive the process of needs assessment and resource allocation. Within this climate new technologies increasingly have to prove their cost-effectiveness. Yet the country case study illustrates that such studies lack established methodologies and wide application. One of the key barriers to diffusion lies within the profession itself, where resistance to paradigmatic change is the strongest force against innovation. The partnership between innovative clinicians and forward-looking managers is important if diffusion of new procedures is to be secured. The discussion of the 10 examples will highlight some of these important issues.