Disenchantment, ambivalence, and the precautionary principle: the becalming of British health policy.

Abstract

Before the election of May 1997, Britain's Conservative government was committed to giving general practitioners a lead role in health service development. However, a qualitative study of managers and primary care workers, charged with implementing the initiative in the south of England, revealed that while many relished the opportunity to make service provision more responsive to local needs, they were concerned that such changes might fragment the National Health Service and damage the relationship between doctor and patient. This ambivalence gave rise to a precautionary principle, in which innovative change was stifled by the desire to avoid adverse consequences. This "becalming" of health policy stemmed from disenchantment with both rational comprehensive planning and quasi-market incrementalism, leaving the government without an ideological basis on which to develop a new organizational form for health sector decision-making. The new Labour government pledged to eradicate the irrationality associated with the internal market. However, a return to the old NHS planning model is not proposed, and Labour is equally committed to involving GPs in commissioning health services at the local level, suggesting that the tension between centralized planning and local incrementalism may continue to undermine the development and implementation of health policy.