This book explains the politics of thirty years of ‘market reform’ in the English NHS, with the rest of the UK a counter-factual. Paton shows how each subsequent reform has been shaped by the confusion left by the previous reform. The long-term ideology has been anti-statist but policy-making at each stage of ‘reform’ has been driven by short-term politics. The outcome in England has been ever-increasing complexity in the NHS, with significantly increased management costs and no commensurate benefit.