Musings about the 'third way' fill the pages of practically every publication that regards itself as a serious shaper of political debate and public policy. Similarly, the websites of the newish, brash centre- left think tanks are bloated with postings on the third way, accumulated through e-mail policy seminars. The purpose of all this frenetic cerebral cyber-activity is to fashion a new politics to underpin the Blair Project. When the prime minister talks endlessly of modernising public services like the NHS, third way thinking is not far away.

But what exactly is the third way? And how does it apply to health policy? After all, the term is used in the white and green papers, though with slightly different meanings.

Is the third way an attempt at finding a middle way between the extremes of a socialist utopia (characterised by command and control, top-down planning) on the one hand, and a capitalist free market (which is neither effectively regulated or constrained in its activities) on the other? Is the third way simply an empty slogan, its importance originating in the most style-conscious of governments? Or, more insidiously, does the third way represent reluctant retreat rather than a distinctive way forward - an acceptance of the recent status quo?1

The third way sits easily alongside the government's insistence that what matters is not who provides services but that the best service is delivered. There is no hang-up over whether a public service is provided publicly or privately as long as best value prevails.

The imprecision of the term 'third way' constitutes both its appeal and its weakness. For some it means nothing more than a revived social democracy. For others it heralds the articulation of a new politics based on concepts of social capital, with a stress on high levels of civic association, strong community networks and local ownership of key institutions.

The notion of social capital is becoming more critical to third way thinking in health, although it, too, is a portmanteau term devoid of precise meaning. Rather like community care, it can mean everything and anything and often does. For instance, those on the new right invoke social capital thinking to justify rolling back the state or to support the view that big government is inherently bad.

In contrast, the new left (and possibly the old, too) employ social capital thinking to justify their calls for renewed efforts at social engineering, using the state actively to nurture and sustain social capital, possibly through the creation of new forms of civic partnership and self-help co- operatives.

The vagueness of social capital thinking is particularly acute when trying to decide the appropriate realms of responsibility for the individual and the state. Until there is clarity on this point, social capital (and hence, possibly, the whole third way approach) is not a useful notion since it can be used to justify contradictory public policy measures.

There is an assumption that the third way and related notions of social capital are a good thing. However, the evidence for such enthusiasm is far from convincing. Is there a downside to such thinking? There must be one, if only because defenders of the third way become extremely defensive if challenged.

From a health policy standpoint there are a number of concerns. Whatever the situation elsewhere, in public policy there is no denying that the complexities of healthcare give rise to a significant information asymmetry between the producers of healthcare and its recipients.

There is much nonsense permeating the notion of social capital, with its stress on the virtues of strong, close-knit, high-trust communities and networks.

But is it not the case that such communities are also able to conceal deep-seated inequalities in social status? And self-help groups can be a source of conflict as well as a force for positive development. Many suffer from the same problems that public service bureaucracies are accused of having. Such groups are not always the havens of innovation and social entrepreneurship that their enthusiastic advocates rather uncritically claim them to be.

But possibly the most serious flaw in third way thinking is the treatment of markets. Third way protagonists are tough on the failings of public bureaucracies, but prefer to handle markets with a gentler touch. Yet it should not be forgotten that many of the social ills evident, which the government seeks to tackle, are the product of contemporary market capitalism.2 Until third way advocates articulate a critique of markets to parallel their critique of public sector bureaucracies, it is hard to see how appropriate policy instruments can be applied to regulate markets in the interests of wider public policy goals.

Healthcare managers may be wondering what all this has to do with their immediate agenda - which is to clear waiting lists and establish effective primary care groups, all by next April.

Well, perhaps this summer's holiday reading might extend to dipping into the extensive literature on the third way, social capital and globalisation. There may in the end be nothing of lasting or added value in any of this for the health sector.

Equally, it would be misguided to dismiss the third way entirely. This government views it with great seriousness as heralding the arrival of a new politics. Since the government is likely to be with us for some time, with several senior ministers - notably Jack Straw and Alan Milburn - prominent third wayers, managers would be well advised to do a spot of homework in preparation for whatever the future may bring.


1 Halpern D, Mikosz D. The Third Way: summary of the NEXUS on-line discussion. NEXUS. 1998.

2 Hutton W. The Observer, 5 July 1998.