The Governance of Health: Medical, Economic and Managerial Expertise in Britain Since 1948

The project’s objective is to understand the changing and interrelated levels of authority held by three types of expert advisers on policy development for the British NHS; medical professionals, health economists and management consultants

Research Themes

Health policy in Britain since the creation of the NHS in 1948 has been the responsibility of government ministers, who have relied on expert advice from a number of sources. They have had constant advice from civil servants (non-political, some medically qualified), and from the late 1960s also began to supplement this through the appointment of special advisers such as Brian Abel-Smith. Government ministers have also benefitted from intermittent and ad hoc contact with senior members of the medical profession: through the Standing Medical Advisory Committees, informal networking and professional representative bodies such as the British Medical Association, the Joint Consultants Committee and the Academy of Medical Royal Colleges. Some commentators have suggested a relative decline in influence that these bodies have exerted on health policy, particularly since the 1970s.

No research to date has attempted to position this changing medical authority relative to the emergence of two new groups of health policy expert advisers: health economists and management consultants, who from the late 1960s have been employed in increasing numbers by the government in new units such as the DHSS Economic Advisers Office, placed within regional health authorities, or on specific consultancies through external companies such as McKinsey & Co. A further source of policy advice has been developed through external think tanks such as the Kings Fund, the Nuffield Trust, the Office of Health Economics and the Institute of Economic Affairs.

This project seeks to understand this hitherto under-researched policymaking transition through the following research questions:

  1. How has the relationship between the government and the medical profession (as represented by the Royal medical colleges and the BMA) changed in Britain in relation to the advent of other sources of expert advice?
  2. How did the discipline of health economics develop and what are the mechanisms through which it has sought to influence health policy?
  3. How have management consultancy businesses developed their interest and involvement in the NHS?
  4. What has been the impact on health policy in Britain of expert medical, economic and managerial advice?

These questions will be addressed through specific case studies to include geriatric care, patient management within hospitals and prescribing policies.