The Rise and Fall of Territory in UK Health Politics

Abstract

Health policy in the UK is experiencing a curious double movement. On the one hand, in what was long considered a highly centralized unitary state, the central UK government is showing steadily less interest in the health policies and outcomes of devolved Northern Ireland, Scotland, and Wales. And on the other hand, within England and the individual devolved health systems, policymakers have created increasingly centralized systems that aspire to dislodge doctors and local boards from their positions of importance. How is it that the UK government simultaneously involves itself in ever more intimate decisions in English health policy while disengaging from most aspects of devolved health policy? The answers, in large part, are to be found in the constitutional structure of the UK. In a country dominated by the English and governed by strong parliamentary governments, there is little to interest a UK government in Scotland and much to interest them in the performance of the English NHS. Electoral concerns lead ministers into concern for the English NHS, while the politics of a multinational state discourage UK government interest in Northern Irish, Scottish, orWelsh policy. The result is the paradox of constitutional decentralization and policy centralization that we see today.