This article explores the commissioning process introduced into the NHS in 1991. Its purpose is to consider the relevance of this experience for future commissioning structures. In particular the implementation of Changing Childbirth (Department of Health 1993) is discussed as an illustration of...

Pressure to utilize research evidence in decisions about patient care and population health, so-called evidence-based medicine, has swept the health care systems of most industrial countries. In the UK, the attention of policy makers has recently turned from the production of more 'effectiveness...