The effects of policy-making within the planning framework of the National Health Service: the relationship between theory and practice

Abstract

The re-organisation of the National Health Service (NHS) in 1974 was intended to have a profound and fundamental effect upon the decision-making underpinning the development and delivery of health care services. Re-organisation was considered necessary on two grounds: first to unite the tripartite structure of health care which had existed since 1948; and second to instil the discipline of a corporate management and planning system into the health service. By the late 1970s it had become clear that the corporate management planning system was not working; certainly not as its procreators had envisaged. The system was judged a failure on four counts: 1) health planning became largely prescriptive;2) it remained essentially incrementalist; 3) very few plans and policies produced were evaluated; and4) an inability to achieve the change envisaged. Given the perceived failure of the corporate management planning system to effect change in the NHS, the study sought to investigate two pertinent issues: firstly, the extent to which the philosophy and rationale of health planning is a guiding force leading to better policies; and secondly, to understand those factors which influence and impinge on the planning process and the resulting policy decisions. It is clear from the investigation that health planning in the NHS has failed to live up to expectations. The study has demonstrated that the introduction of a formal planning system into an organisation, however well-intended, is of itself not enough without additional and continuing support. In the local case study, mechanisms and procedures were established and adhered to, and yet very little in the way of acceptable and implementable plans were produced. Nevertheless policy changes did occur and a number of factors can be cited as explanation for this phenomenon. Leadership emerged from the study as being a crucial ingredient in any recipe for planning and policy-making. Power was another dominant factor which was generally applied in a negative sense but when used in a positive way, dramatic results were possible. The third ingredient necessary for effective planning and policy-making was involvement not only of others in the organisation but also of the public. However having these attributes is not enough and the study has demonstrated the need for a more integrated style of planning, policy-making and management, and a concept of strategic management is proffered as an appropriate vehicle for creating within the NHS the desired future change consistent with the needs of the public.