England in a UK Context: Diversity of Governance

Abstract

Paton shows how Scotland and the rest of the UK took a different path from England after devolution in 1998. He goes on to analyse how confused thinking about governance in England led to policy overload there, as successive ‘problems’ (inadequately defined or justified as problems) led to successive policy changes reflecting different approaches to governance. Overall, trust in professionals was reduced increasingly. The so-called collaborative approach was quickly abandoned and replaced with central control through government targets for the NHS. These in turn were allegedly replaced with ‘the new market’ but in fact the latter was an addition rather than a replacement. Government advisers at the time thought that professionals required control, and government took a scatter-gun approach to imposing different, often incompatible, means of control. There was no evidence-based policy as opposed to (at best) policy-based evidence. Reasons why choice and the new market, after 2002 and more substantially after 2006, did not work as intended include the fact that market-based assumptions about what motivates health service clinicians, managers, and Boards are wrong.