Narratives of Health Policy

In this chapter we undertake a narrative analysis of health care policy reform. We consider the beguiling and rhetorical quality of health care policy reform, and how it positions “heroes” and “villains” as it attempts to shape imagined futures, under three narrative themes—management, measurement; markets. However, we highlight the policy narrative is not entirely beguiling. A countervailing professional narrative argues that regulatory bodies and clients put their trust in the experts, which has made change slow to realize in some areas. Meanwhile, a narrative critical of policy reform makes the case for a return to bureaucracy to counter excesses of flexibility, adaptability and emphasis upon delivery associated with new public management and entrepreneurial governance. To illustrate our analysis, we draw upon a particularly propitious health care setting for policy reform, that of the English NHS. We suggest our analysis is not just transferable to other national contexts, underpinned by new public managment policy, but extends to reforms in other national settings, although the detail of the management, measurement and market themes may vary on the ground, as illustrated in the case of the US and Nordic countries.