Choice and change in health care in Britain

Health authorities in Britain are under pressure to shift the balance of health care towards long-term patients and non-hospital services. Financial cut-backs mean that changes in priorities can no longer be implemented from development monies alone and there is a need to take resources from existing services. At first glance, the least difficult option appears to be to make savings in the ways in which care is delivered rather than to cut or abolish whole services or to reduce 'standards' of care. However there are factors other than resource constraints which influence the ability of health authorities to choose and implement shifts of resources; they include professional and technical developments, lay expectations and health service management structures and processes. These factors and their implications are reviewed and issues are identified which are amenable to research by existing groups of research workers.