The Politics of Health Policy Reform in the UK: England’s Permanent Revolution PDF
Preview The Politics of Health Policy Reform in the UK: England’s Permanent Revolution
The Politics of Health Policy Reform in the UK England's Permanent Revolution Calum Paton The Politics of Health Policy Reform in the UK Calum P aton The Politics of Health Policy Reform in the UK England’s Permanent Revolution Calum Paton Keele University United Kingdom ISBN 978-1-137-47342-4 ISBN 978-1-137-47343-1 (eBook) DOI 10.1057/978-1-137-47343-1 Library of Congress Control Number: 2016950007 © The Editor(s) (if applicable) and The Author(s) 2 016 The author(s) has/have asserted their right(s) to be identifi ed as the author(s) of this work in accordance with the Copyright, Designs and Patents Act 1988. This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Palgrave Macmillan imprint is published by Springer Nature The registered company is Macmillan Publishers Ltd. London ‘Dedicated to my wife Tracey, my daughter Leah, my son Josh - and also to my mother and late father who gave me a start (and much more) in life’ F OREWORD This book is in many ways the culmination of my research and work over more than 30 years on the politics and substance of the so-called NHS reforms and of evolving health policy in general (primarily ‘mar- ket reforms’, pursued at fi rst in the UK and subsequently England alone since devolution). Resultingly, amongst the references are quite a few to some of my earlier works on particular, earlier reforms. The reader should interpret this as a shortcut to more detailed work and more references on individual reforms rather than as evidence of an oversized ego on my part. Another word about references: some statements in the book, and refer- ences to people (politicians, NHS leaders, and others), are based on con- fi dential interviews and conversations either with these people or about these people. Rather than clutter the text with notes which simply say, ‘Confi dential interview’ or ‘Conversation with the author’, I have simply let them stand. Where there is an unattributed or unreferenced statement by or about a key actor or event, it falls into this category. The book both tells the story of reform and seeks to explain it in terms of political science. I have attempted to create a narrative which does not make the distinction between storytelling and explanation too stark, that is, to minimise jargon in the latter and structure the former in terms of key political and policy episodes. This means that, in some cases, the political explanation comes at the end of a chapter (as with Chap. 1 , dealing with the original Thatcher reforms) and, in other cases where there is a need for it, the political explanation comes in chapters of its own (e.g. Chaps. 3 , 7 , and 8 ) . In general, the book follows a chronology (from the origins of the ‘internal market’ policy to the present day) but within and between c hapters, vii viii FOREWORD some issues are treated outside this strict chronology in order to aid the analysis. To give just one example, Foundation Trusts are treated later than a strict chronology would imply, so that the continuity between New Labour and subsequent Coalition policy can be explored. I NTRODUCTION This book aims to explain why and how health policy has changed, and the NHS has been ‘reformed’, over the last 30 years. In terms of what is understood by policy, the most attention—and certainly international attention—has been focused on the UK and English ‘market reforms’ which were initiated in the UK in the late 1980s and continued in England after devolution in 1998, unlike in the rest of the UK. The primary aim of this book is to explain the causes and the course of these reforms, which have rightly come to be identifi ed with England rather than with the whole UK. Thus by policy reform, I refer to the national set of reforms which have repeatedly restructured the NHS—not to all possible mean- ings of the term ‘policy’ at all levels within the system. Of course the type of policy reform which I investigate affects other types of policy, not least through diverting attention from other policy priorities, and attention is drawn to this in various places below. Much has been written about the objectives of ‘the reforms’, especially as proclaimed by their progenitors, about whether or not these objec- tives have been achieved (Le Grand et al. 1998; Mays et al. 2011), and about whether or not there have been other outcomes, especially of the perverse sort (Paton et al. 1998; Paton 2006). And the politics of ‘the reforms’ have been discussed whenever the UK (subsequently England) has embarked on yet another round of reorganisation in pursuit of reform. Yet these political explanations have not been adequately reconciled and synthesised. And more importantly, there has not been an adequate ix
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