Consultative Processes in Health Policy in the United Kingdom: A View From the Centre

Abstract

Health policy at national level is the product of a series of continuous and complex interactions between interest groups operating both inside and outside government. It is generally thought that these consultative processes are closed, elitist and dominated by the prestigious medical specialties. Yet there has been a rapid growth in the number of groups representing various interests, professions and care groups. Drawing on recent examples from the national health service, the paper explores the extent to which consultative processes in health policy have remained closed or have been opened up to new influences. The analysis suggests that consultation within the health department is more pluralistic than is usually appreciated. Also, while the closed, elitist mode of consultation with external interests has been eroded marginally, it remains more or less intact. Nevertheless, the ability of powerful medical interests to get their own way to the exclusion of other interests depends on the resources and sanctions available to other groups and on the particular policy issue. It can no longer just be assumed.

Providing Integrated Health and Social Care for Older Persons in the United Kingdom

“…In relation to health, policy making for older people has been largely influenced by a 'policy community' or 'iron triangle' (Haywood and Hunter 1982) centred on the Department of Health. This involves ministers and professional expertise within the department, as well as national groups such as the British Geriatric Society.…”

Change in the Governance of Medicine: the politics of self-regulation

“…Much to the medical profession's chagrin, the overhaul of the medicine/state relationship duly took place with the promotion of NHS managers as a power group to rival the doctors, the erosion of the established 'iron triangle' of the medical profession, officials and ministers, 30 the abolition of medicine's policy veto and its exclusion from the inner sanctum of policy making from the 1988 Review of the NHS onwards, and, as the doctors' wounded surprise turned to anger, a series of acrimonious disputes between the profession's leaders and successive secretaries of state for health. 31 Yet, although significant aspects of the original corporatist agreement were dismantled, the state made no attempt to challenge the basis of medical power: the principle of self-regulation itself.…”

The Paradox of Policy Diversity in a Unitary State: Community Care in Britain

“…Whatever the explanation, pressure for change is weak and comes mainly from interest groups and 'issue networks' operating outside the WS, of which the Care in the Community Scottish Working Group (representing 22 voluntary bodies) has been the most influential example. As in England, the influence of such lobbies and networks ought not to be discounted in the formation of policy (Haywood and Hunter 1982). Also, it is conceivable that, were services under greater pressure in resource terms, such pressure would have been the trigger for a wider debate about community care, as seems to have been the case in part in England.…”

“…In a recent study (Hunter and Wistow 1987), we have sought to test the validity of such views in the health and personal social services in mainland Britain. Drawing on interviews with senior officials in the two territorial offices, as well as earlier work conducted separately in the DHSS (Haywood and Hunter 1982;Jasp Team 1984), we have sought to draw out the respective roles of each department in the processes of policy-making and administration, especially as they relate to community care. More particularly, we have been concerned with two central issues: the extent to which DHSS actually operates as the lead department for this field of policy; and how far such diversity as exists is confined to variations in the means through which common policies are pursued, rather than reflecting more fundamental divergences in the policy stances adopted by different departments.…”