Regulatory governance in the National Health Service 1985-2004 : analysing selected reform initiatives
This thesis analyses the growth of regulation in the National Health Service (NHS) between 1985 and 2004. It argues that the development of the NHS over this period conforms to the pattern, asserted more generally in existing scholarship, of a rise of the regulatory state in Western European countries. One conventional explanation for the pattern of development-the increasing importance placed on establishing credible policy commitments-is shown to be compatible with observed patterns of development in the NHS. Building on earlier work, which argued that the organisation of the NHS was underpinned by an implicit concordat between politicians and the medical profession, it is argued that regulatory state type institutions potentially reconcile the imperative of credible commitment to the concordat with demands for greater governmental intervention in the provision of health services. Adapting an analytical framework developed by Brian Levy and Pablo Spiller, this thesis argues that regulatory reforms in the NHS are unlikely to achieve their publicly pronounced objectives if the legal and administrative framework for regulation does not demonstrate credible commitment to the implicit concordat. This is labelled the 'regulatory commitment hypothesis'. In order to assess the plausibility of this hypothesis, three episodes of regulatory reform are examined which, on the basis of the modified Levy and Spiller framework, can be said to engender varying degrees of commitment. The three episodes are: (1) the Limited List of NHS Drugs; (2) The National Institute for Clinical Excellence; and (3) the Commission for Health Improvement. Overall, an examination of these three episodes of regulatory reform provides grounds for cautious support for the regulatory commitment hypothesis.