POLICY AS NARRATIVE: NEW LABOUR'S REFORM OF THE NATIONAL HEALTH SERVICE

In: Public administration: an international journal, Band 84, Heft 2, S. 367-385

Abstract

Beginning with a brief review of the governance literature, a definition of governance in the National Health Service of England and Wales (NHS) is offered. This introduces an analysis of NHS reform, as presented in the recent policy literature. Using narrative theory, I critique this literature with reference to three key actors: the new organizational form of the 'Foundation Trust', NHS staff, and NHS patients. For each actor, a motif is identified and examined: 'freedom' for Foundation Trusts, 'clinical governance' for staff, and 'choice' for patients. Each of these motifs is instrumental in the narrative on NHS reform, whose main themes are emancipation, progress and duty. These are common to other political projects. This critique makes the rhetoric underpinning the recent policy literature more explicit, and underlines the created, contingent nature of New Labour's account of NHS reform.