Normalized management of HIV prevention services in an advanced liberal NHS in the 1990s

Abstract

This paper examines how responsibility for the planning of state-funded HIV prevention services shifted from UK central government to local commissioners during the ‘era of normalization’ in the 1990s. It explores whether according to literature from the period these changes experienced were those that would be predicted by theories of ‘advanced liberalism’, i.e. delegation of operational planning, centralization of strategic target setting, and increased scrutiny of ‘expert’ providers. The paper examines the changes that were described in power relations among key players, using advanced liberalism to structure this examination. The paper concludes that many but not all of the reported changes conformed to these predictions. Although the government did set targets, these targets did not function as effective levers on local activity. Although delegation of planning to local commissioners did occur, their authority was restrained by the retention of specific earmarked HIV prevention funding. Although scrutiny was applied to those with expert status providing services, some—especially those in the voluntary sector—appear to have been scrutinized more than others, such as various clinical practitioners.