British Politics

, Volume 3, Issue 2, pp 183–203 | Cite as

Reconciling Two Conflicting Tales of the English Health Policy Process Since 1997

  • Arturo Alvarez-Rosete
  • Nicholas Mays


This article identifies and investigates the two seemingly conflicting tales that characterise the English health policy process at the national level since 1997. The first tale points to a high degree of central political control over the initiation and development of policy, and the maintenance of the system of strong central government, traditionally referred to as the ‘Westminster and Whitehall model’. The second tale describes a system of ‘network governance’, suggesting a more complex health policy process in which central government (in particular, the Department of Health as its agent) is weaker than before and no longer holds a monopoly over the health policy-making process. The paper reviews the limited empirical evidence on the English health policy process since 1997 to determine which of the two narratives more accurately captures the nature of it at the national level. It concludes that, while many of the trends noted by the ‘from-government-to-governance’ thesis are evident in the case of health policy, the process has been less affected than other areas of public policy by the appearance of new actors, the move to new institutional arenas and the transformation of relationships. Rather than one of the tales being right and the other wrong, as the literature in this area tends to suggest, it is more accurate to describe the current situation as marked by the simultaneous presence of different modes of policy-making — both ‘command-and-control’ as well as a more inclusive, complex set of mechanisms. Indeed, top-down coordination and control of the policy process may be seen as a response to the greater practical difficulties facing the ‘core executive’ in managing policy processes that involve an increased number of influential actors.


health policy NHS Westminster and Whitehall model governance policy process policy formulation policy implementation core executive 


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Copyright information

© Palgrave Macmillan Ltd 2008

Authors and Affiliations

  • Arturo Alvarez-Rosete
    • 1
  • Nicholas Mays
    • 2
  1. 1.King's Fund, 11–13 Cavendish SquareLondonUK
  2. 2.Department of Public Health and PolicyHealth Services Research Unit, London School of Hygiene and Tropical MedicineLondonUK

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