The Politics of Health Policy Reform in the UK

England’s Permanent Revolution

  • Calum Paton

About this book


‘Calum Paton has long been one of our most insightful health academics. Rigorous in his approach, he has never been afraid to swim against the ever shifting tides of received opinion. His latest book which is the culmination of decades of analysis of the impact of politics on evolving health policy is a tour de force. Beautifully written, it exposes the fragility of much of the thinking behind the endless re-organisations and re-structurings endured by the NHS. He castigates both the right and the left who for widely opposing reasons have subjected  the NHS to  an overbearing audit and tick box oversight that chokes off the altruism of staff and gets in the way of improving services. At a time when the NHS is so much under the cosh both politically and financially, his book is a timely warning to all sides of the debate that pre conceived political ideologies are not the basis for progress; nor too, a woolly consensual approach seeking in vain to take the NHS out of politics. He acknowledges no magical solution but argues that awareness of the problems caused by market solutions or so called public service reforms is at least a start. Calum's book is a must read for all concerned about the NHS and its future.’– The Rt Hon. the Lord Hunt of Kings Heath OB, President of the Royal Society for Public Health

‘Calum Paton's book traces 25 years of NHS re-organisations (or re-disorganisations). He offers a detailed and insightful examination of the twists and turns of policy and the effects that this has had, and indeed the causes of the current state of affairs. The author argues that underlying and persistent political beliefs concerning such things as the role of the market reveal both arational and irrational aspects of policy making, which need to be seen in the broader context of the British political scene. Calum Paton writes, as always, with wit and aplomb together with a keen theoretical perspective and a wry sense of humour.  It's a fascinating journey through the history of NHS policy, and anyone who wants to understand how and why the NHS ended up in another fine mess, should read this book.’– Dr Alison Hann, Senior Lecturer in Public Health and Policy Studies, Swansea University, UK

This book explains  the politics of thirty years of ‘market reform’ in the English NHS, with the rest of the UK a counter-factual. Paton shows how each subsequent reform has been shaped by the confusion left by the previous reform. The long-term ideology has been anti-statist but policy-making at each stage of ‘reform’ has been driven by short-term politics. The outcome in England has been ever-increasing complexity in the NHS, with significantly increased management costs and no commensurate benefit.

Calum Paton is Emeritus Professor of Public Policy at Keele University, UK. His books include seminal analyses of the Thatcher and Blair reforms to the NHS. He is Editor-in-Chief of the International Journal of Health Planning and Management. He was Chair of the University Hospital of North Staffordshire NHS Trust from 2000 to 2006, and has advised politicians in the UK, governments abroad and agencies such as WHO, World Bank, UNDP, and the EU.  


National Health Service Market reforms Management Thatcherism Neoliberalism health health policy political science politics public policy reforms

Authors and affiliations

  • Calum Paton
    • 1
  1. 1.Keele UniversityKeeleUnited Kingdom

Bibliographic information