ABSTRACT
This chapter focuses on the different modes of explanation, as appropriate, in tracing the evolution of policy from the decision to set up the Review to the implementation of the proposals set out in Working for Patients. The increasingly fierce political debate about National Health Service (NHS) funding that characterised the 1980s was revealing not so much for any conclusions reached about the adequacy or otherwise of its budget but for its demonstration that it was impossible to come to anything like an agreed verdict. Decisions about the appropriate level of spending on health care would be largely de-politicised because diffused among consumers, the NHS’s budget would depend on its ability to attract customers in the face of competition from other providers. The Department of Health, which might have been expected to take the lead in shaping the agenda of any Review of the NHS, turned out to be ineffective in this role.
