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Dismantling the NHS?Evaluating the Impact of Health Reforms$
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Mark Exworthy, Russell Mannion, and Martin Powell

Print publication date: 2016

Print ISBN-13: 9781447330226

Published to Policy Press Scholarship Online: May 2017

DOI: 10.1332/policypress/9781447330226.001.0001

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Orders of change in the ordered changes in the NHS

Orders of change in the ordered changes in the NHS

(p.17) Two Orders of change in the ordered changes in the NHS
Dismantling the NHS?

Martin Powell

Policy Press

The author introduces the difficulty in conceptualising or measuring change in health systems. The author states that in this chapter draws on the account of Hall which differentiates between first, second and third order change. It views policymaking as a process that usually involves three central variables: the overarching goals that guide policy in a particular field, the techniques or policy instruments used to attain those goals, and the precise settings of those instruments. Hall regards change in settings as first order change; changes in instruments and settings as second order change; and changes in all three components – instrument settings, the instruments themselves and the goals – as third order or paradigm change. Implementing some aspects of this approach, this chapter tracks the main policy measures introduced by the Coalition’s Health and Social Care Act of 2012 backwards to the Conservative government of 1979.

Keywords:   Health and Social Care Act, Conservative government, health systems, change, policymaking

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