Delivering reform in English healthcare: An ideational perspective

Abstract

A variety of perspectives has been put forward to understand reform across healthcare systems. Recently, some have called for these perspectives to give greater recognition to the role of ideational processes. The purpose of this article is to present an ideational approach to understanding the delivery of healthcare reform. It draws on a case of English healthcare reform – the Next Stage Review led by Lord Darzi – to show how the delivery of its reform proposals was associated with four ideational frames. These frames built on the idea of ‘progress’ in responding to existing problems; the idea of ‘prevailing policy’ in forming part of a bricolage of ideas within institutional contexts; the idea of ‘prescription’ as top-down structural change at odds with local contexts; and the idea of ‘professional disputes’ in challenging the notion of clinical engagement across professional groups. The article discusses the implications of these ideas in furthering our understanding of policy change, conflict and continuity across healthcare settings.