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Abstract
Transforming health systems is a complex, messy business with no quick or simple solutions. Countries struggle to make it happen with policy failure often the result. Reporting on a World Health Organization Europe project aimed at understanding how health system transformation can succeed, the paper draws on three European country case studies to offer insights and lessons for policy-makers elsewhere engaged in similar efforts. Critical to success in implementation is the adoption of a receptive context for change. Building on the policy capacity literature, it emphasizes the importance of environmental pressure, the quality and coherence of policy, leadership style, supportive organizational culture, and managerial-health profession relations.

Studies of policy‐making and management in health and related fields have generally been confined to England even when professing to embrace Britain or the United Kingdom. The assumption of a unitary state in which the policy lead is given by Westminster/Whitehall is shown to be grossly misleading in the case of community care policy. Considerable variations exist not only in policy means but also in policy ends. The paper demonstrates the limitations of studying health and personal social services adopting a unitary state perspective. It argues for more intra‐Britain comparative work aimed at evaluating the costs and benefits of service variations in different policy fields.

Health policy at national level is the product of a series of continuous and complex interactions between interest groups operating both inside and outside government. It is generally thought that these consultative processes are closed, elitist and dominated by the prestigious medical specialties. Yet there has been a rapid growth in the number of groups representing various interests, professions and care groups. Drawing on recent examples from the national health service, the paper explores the extent to which consultative processes in health policy have remained closed or have been opened up to new influences. The analysis suggests that consultation within the health department is more pluralistic than is usually appreciated. Also, while the closed, elitist mode of consultation with external interests has been eroded marginally, it remains more or less intact. Nevertheless, the ability of powerful medical interests to get their own way to the exclusion of other interests depends on the resources and sanctions available to other groups and on the particular policy issue. It can no longer just be assumed.

Recent years have witnessed a growing concern in the NHS to devise and implement policies which explicitly recognise that certain client groups and services should receive a higher priority. The paper points to problems arising from the formulation and implementation of the Scottish health priorities documents, drawing where appropriate on related developments in England. Three areas are highlighted for analysis: the policy ambiguity inherent in the documents; problems of collaboration in implementing the policies; and problems posed by central-local relations. The paper concludes that there is a need for a more sophisticated response to the present fiscal squeeze than simply defending the status quo and suggests that the squeeze could provide the necessary stimulus for change.

Drawing on in-depth case studies across England, this book argues that governance and population health are inextricably linked. Using original research, it shows how these links can be illustrated at a local level through commissioning practice related to health and wellbeing. Exploring the impact of governance on decision- making, Governance, commissioning and public health analyses how principles, such as social justice, and governance arrangements, including standards and targets, influence local strategies and priorities for public health investment. In developing 'public health governance' as a critical concept, the study demonstrates the complexity of the governance landscape for public health and the leadership qualities required to negotiate it. This book is essential reading for students, academics, practitioners and policy-makers with an interest in governance and decision-making for public health

Background Findings are presented from the evaluation of Public Health England's (PHE) Prioritization Framework (PF) aimed to assist local authority commissioners with their public health investment and disinvestment decisions. The study explored the take up of the PF in three early adopter local authority settings. Methods Semi-structured interviews (n = 30) across three local authorities supplemented by participant observation of workshops. Results Participants acknowledged that the PF provided a systematic means of guiding priority-setting and one that encouraged transparency over investment and disinvestment decisions. The role performed by PHE and its regional teams in facilitating the process was especially welcomed and considered critical to the adoption process. However, uptake of the PF required a significant investment of time and commitment from public health teams at a time when resources were stretched. The impact of the political environment in the local government was a major factor determining the likely uptake of the PF. Ensuring committed leadership and engagement from senior politicians and officers was regarded as critical to success. Conclusions The study assessed the value and impact of PHE's PF tool in three early adopter local authorities. Further research could explore the value of the tool in aiding investment and disinvestment decisions and its impact on spending.

Reforming healthcare: What's the evidence? is the first major critical overview of the research published on healthcare reform in England from 1990 onwards by a team of leading UK health policy academics.

"Health systems everywhere are experiencing rapid change in response to new threats to health, including from lifestyle diseases, risks of pandemic flu, and the global effects of climate change. At the same time, health inequalities continue to widen despite efforts to halt and reverse them. Such developments have profound implications for the future direction of public health policy and practice. The Public Health System in England offers a wide-ranging, provocative and accessible assessment of challenges confronting a public health system, exploring how its parameters have shifted over time and what the origins of long-standing dilemmas in public health practice are. The book will therefore appeal to public health professionals and students of health policy and may also encourage them to become fully engaged in political and social advocacy alongside the traditional skills of reasoned analysis and sound evidence."--Publisher's description

Context: Policy implementation is an often overlooked stage when policy is introduced. Too often the result is policy failure caused by overly optimistic expectations, implementation in dispersed governance, inadequate collaborative policy-making, and the vagaries of the political cycle. The Care Act 2014 introduced the most significant change in social care law in England for 60 years. Given the complexity of the changes, the Department of Health and Social Care and its key partners introduced an Implementation Support Programme (ISP) to increase the likelihood of smooth implementation. Objective: To assess the impact of the ISP on local implementation of the Care Act and develop a framework for understanding the requirements of a successful ISP. Methods: Analysis was undertaken of the relevant theoretical and conceptual literature in addition to a review of support programmes for other national policies. The empirical study of the impact of the Care Act's ISP, conducted in six local authorities, focused on three levels of activity that shaped outcomes: national, regional and local. Data were collected through interviews with key stakeholders at each level. Findings: The ISP enjoyed several successes including: helping to secure policy legitimacy, developing stakeholder engagement, sustaining political support, and ensuring the readiness of local implementation agencies. Limitations: The empirical research was confined to six English local authorities which limits drawing general conclusions applicable to the whole country. Implications: Little evidence exists on the value of ISPs. The research goes some way to closing the gap and offers provisional messages on their value to policy-makers and practitioners.