Understanding NHS Policy Making in England: The Formulation of the NHS Plan, 2000

Abstract

• The article investigates which of two competing accounts of contemporary British policy making better captures the nature of policy making during episodes of major reform of the English NHS.
• The analysis of the formulation of the English NHS Plan 2000 suggests that the Asymmetric Power Model better describes the reality of NHS policy making under New Labour than the Differentiated Polity Model.
• Although the process of developing the Plan showed signs of a more open policy process, it was tightly controlled and personally led by the Secretary of State for Health and his close advisers, reflecting an underlying British political tradition that emphasises the idea that the NHS has to be continuously improved with change led from above by central government.
• However, when compared to the processes underpinning Thatcher's Ministerial Review of the NHS and the 2010 Coalition government's White Paper, if ever NHS policy making in England were to have come close to the Differentiated Polity Model, it would have been during the formulation of the 2000 NHS Plan.

Through a case study of the formulation of the English NHS Plan 2000, this article investigates which of two competing models of the British policy process—the Differentiated Polity and Asymmetric Power Models—better describes the reality of major NHS reform policy making under New Labour. The process of developing the Plan showed signs of a more open policy process, seemingly closer to the DPM. There was contestability of policy advice and limited involvement of the medical profession through its representative bodies. However, the process was tightly controlled and personally led by the Secretary of State and his advisers, with the direct involvement of the Prime Minister throughout. Two key moments of interest group involvement—the Modernisation Action Teams and the signing of the Plan by health sector organisations—were marked by power asymmetries. Overall, the APM better describes the reality of major reform policy making under New Labour.