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Much of the management effort in the National Health Service (NHS) over the last few years has been directed towards increasing the responsiveness of the service to the consumer. The aims set out in the 1989 White Paper, Working for Patients, are explored, concentrating on the cultural and structural changes within the NHS that, in the area of customer orientation and service, are necessary for success in the new market economy. The involvement of the consumer in all aspects of the delivery of health care is stressed.

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