Initial evaluations of Thatcherism suggest that it represented a policy formulation success but implementation failure (Marsh and Rhodes 1992), with healthcare reforms particularly unsuccessful because they did not challenge the autonomy of the medical profession (Wistow 1992a and 1992b). More extensive analyses of the implementation of new public management (NPM) within health care take this challenge more seriously. According to Ferlie et al. (1996), doctors were gainers and losers, since the rise of the management function coincided with a rise in medical involvement in management decisions. However, this article argues that the rise of the purchasing function of health authorities undermined this ‘gain’ to the medical profession. Further, the significance of the case study—AIDS policy in Scotland—is that profound change has occurred in a policy area in which one would least expect this to happen.
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References
1.
ACMD (1988) AIDS and Drug Misuse, Part 1, Report by the Advisory Council on the Misuse of Drugs (London: HMSO).
2.
BaggotR. (1995) ‘From confrontation to consultation? Pressure group relations from Thatcher to Major’, Parliamentary Affairs, 48:3, 484–502.
3.
BerridgeV. (1996) The Making of AIDS Policy 1981–1994 (Oxford: Oxford University Press).
4.
BrettleR. (1996) ‘Did the band play on?’1st George Bath Memorial Lecture, Royal College of Physicians, Edinburgh.
5.
BurchM.HollidayI. (1996) The British Cabinet System (London: Prentice Hall/Harvester Wheatsheaf).
6.
CurrieE. (1989) Lifelines (London: Sedgewick and Jackson).
7.
DayP.KleinR. (1992) ‘Constitutional and distributional conflict in British medical politics: The case of general practice 1911–1991’, Political Studies, 40, 462–478.
8.
DH (1989) Working For Patients, presented to parliament by the secretary of state for health … [et al.], Cm 555 (London: HMSO).
9.
ElstonM. (1991) ‘The politics of professional power—medicine in a changing health service’, in GabeJ.CalnanM.BuryM. (eds), The Sociology of the Health Service. (London: Routledge), pp. 58–88.
10.
FerlieE.AshburnerL.FitzgeraldL.PettigrewA. (1996) The New Public Management in Action (Oxford: Oxford University Press).
11.
FitzgeraldL.FerlieE. (2000) ‘Professionals: Back to the future?’, Human Relations, 53:5, 713–739.
GarfieldS. (1994) The End of Innocence (London: Faber and Faber).
14.
GrantW. (1995) Pressure Groups, Politics and Democracy in Britain (2nd edn) (London: Philip Allen).
15.
GreenwoodJ. (1990) ‘Creating a new drug service in Edinburgh’, British Medical Journal, 300, 587–589.
16.
GreenwoodJ. (1996a) ‘Shared care with general practitioners for Edinburgh's drug users’, The International Journal of Drug Policy, 7:1, 19–22.
17.
GreenwoodJ. (1996b) ‘Six years’ experience of sharing the care of Edinburgh's drug users’, Psychiatric Bulletin, 20, 8–11.
18.
GreenwoodJ. (1997) ‘Some critical observations about shared care when viewed through the retirement retroscope’, mimeo.
19.
HamC. (1994) ‘Where now for the NHS reforms?’, British Medical Journal309, 351–352.
20.
HamC. (1999) Health Policy in Britain (4th edn) (London: Macmillan).
21.
HarrisonS. (1999) ‘Clinical autonomy and health policy: Past and futures’ in ExworthyM.HalfordS. (eds), Professionals and the New Managerialism in the Public Sector. (Buckingham: Open University Press), 25–36.
22.
HarrisonS.HunterD. J.MarnochG.PollittC. (1992) Just Managing: Power and Culture in the National Health Service (London: Macmillan).
23.
HC 148-I (1990) The Government's Plans for the Future of the NHS, Minutes of Evidence of the Social Services Committee, Session 1989–1990 (London: HMSO).
24.
HC 614-I (1991) Public Expenditure on Health and Personal Social Services, Third Report from the Health Committee, Session 1990–1991 (London: HMSO).
25.
HC 902 (1993) Memorandum from the Department of Health on Public Expenditure on Health and Personal Social Services, First Special Report from the Health Committee, Session 1992–1993 (London: HMSO).
26.
HeadeyB. (1974) British Cabinet Ministers (London: George Allen and Unwin Ltd).
27.
IMG (Information Management Group) (1990) Working For Patients: Framework for Information Systems—The Next Steps (London: HMSO).
28.
JordanA. G.MaloneyW. A. (1997) ‘Accounting for subgovernments: Explaining the persistence of policy communities’, Administration and Society, 29:5, 557–583.
29.
JordanA. G.RichardsonJ. J. (1987) Government and Pressure Groups in Britain (Oxford: Clarendon Press).
30.
KleinR. (1995) The New Politics of the NHS (3rd edn) (London: Longman).
31.
Lothian Health Board (1988) AIDS in Lothian: Everyone's Concern, Report in response to the AIDS (Control) Act 1987.
32.
Lothian Health (1997) ‘The funding of combination drug therapies for HIV infection’, Board Meeting, 13 May.
33.
LowndesV. (1999) ‘Management change in local governance’, in StokerG. (ed.), The New Management of British Local Governance. (London: Macmillan), 22–39.
34.
MaloneyW. A.JordanA. G.McLaughlinA. M. (1994) ‘Interest groups and public policy: The insider/outsider model revisited’, Journal of Public Policy, 14:1, 17–38.
35.
MarshD.RhodesR. A. W. (eds) (1992) Implementing Thatcherite Policies (Buckingham: Open University Press).
36.
McLellandD. (1986) HIV in Scotland, Report of the Scottish Committee on HIV Infection and Intravenous Drug Misuse (Edinburgh: Scottish Home and Health Department).
37.
MetcalfL. (1993) ‘Conviction politics and dynamic conservatism—Thatcher managerial revolution’, International Political Science Review, 14:4, 351–371.
38.
RhodesR. A. W. (1998) ‘Different roads to unfamiliar places: UK experience in comparative perspective’, Australian Journal of Public Administration, 57:4, 19–31.
39.
RichardsD.SmithM. J. (1997) ‘How departments change: Window of opportunity and critical junctures in three departments’, Public Policy and Administration, 12:2, 62–79.
40.
RichardsonA. M.GaskellP. A. (1989) ‘HIV infection and AIDS in Lothian’, in PyeM.KapilaM.BuckleyG.CunninghamD. (eds), Responding to the AIDS Challenge. (London: Longman), 99–118.
41.
RoseR. (1986) ‘Steering the ship of state: One rudder but two pairs of hands’, Appendix 15 of HC 92-II (1986), Civil Servants and Ministers: Duties and Responsibilities, Seventh Report from the Treasury and Civil Service Committee, Session 1985–1986.
42.
SabatierP. A. (1993) ‘Policy change over a decade or more’, in SabatierP. A.Jenkins-SmithH. C. (eds), Policy Change and Learning: An Advocacy Coalition Approach. (Boulder, CO: Westview Press), 13–40.
43.
SmithM. J. (1993) Pressure, Power and Policy (Hemel Hempstead: Harvester Wheatsheaf).
44.
WistowG. (1992a) ‘The health service policy community: Professionals pre-eminent or under challenge?’, in MarshD.RhodesR. A. W. (eds), Policy Networks in British Government. (Oxford: Oxford University Press), 51–74.
45.
WistowG. (1992b) ‘The National Health Service’, in MarshD.RhodesR. A. W. (eds), Implementing Thatcherite Policies. (Buckingham: Open University Press), 100–116.
