Continuity and Change in Public Policy and Management
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Continuity and Change in Public Policy and Management

Christopher Pollitt and Geert Bouckaert

Combining theory development, international comparison and original case study analysis, two of Europe’s leading public policy and management scholars apply and develop some of the main models of policy change and offer a revealing long-term view of policy developments since 1965. Drawing on an extensive programme of elite interviews and documentary analysis they provide an integrated treatment of national and local policymaking in two major public services – hospital care and the police – in England and Belgium. This timely book addresses the ‘paradigm wars’ in public policy, arguing for a nuanced intermediate position that challenges the orthodox and the post-modernists alike.
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Chapter 3: National Reforms: Hospitals

Christopher Pollitt and Geert Bouckaert


INTRODUCTION Chapter 2 provided a very brief, high-level introduction to policymaking in England and Belgium. In this chapter and the next we will dive deeper into our two selected policy sectors – hospitals in this chapter and the police in Chapter 4. The first step is to identify the main institutional players in national policymaking (section 3.2) and after that we will set out the English and Belgian policy chronologies for the period from 1965 to 2005 (section 3.3). After that we begin the analysis of change and continuity, similarities and differences. 3.2 3.2.1 KEY INSTITUTIONS IN HOSPITALS POLICY English Hospitals The main players in England over the whole period were central government, the medical profession (both locally, in the hospitals, and centrally, through its national representative associations) and the hospitals themselves. However, the balance between these three has certainly shifted more than once, and arguably an important new player has emerged since the mid-1980s, in the shape of professional National Health Service (NHS) managers. Local governments have never had any serious influence over the development of NHS hospitals, except insofar as they can limit infrastructural developments through their use of land use planning legislation. An authoritative recent textbook divides the key developments in formal organization into the following phases (Harrison and McDonald, 2008): ● 1948–79, ‘The illusion of hierarchy’. Hospitals were supervised by regional boards that were in turn responsible to the Ministry of Health. From the outset the Minister therefore had a strong responsibility for the whole NHS. In...

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