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The article explores the challenges and risk for the potential development of a new public health system in England in 2011. It says that the decision to implement a radical change in the system is due to several indicators and facts such as the dependency of 1.6 million people on alcohol. It also mentions that the change is in line with the aim of government to address the problems regarding long-term poor mental health in the country. According to the author, the improved health system is expected to enhanced the lifestyle of families in the poorest areas.

There has been a succession of policy documents related to active travel published by the British government since the implementation of a National Cycle Network (NCN) in 1995. However, as the latest National Travel Survey (NTS) reveals, the number of journeys made by bike in the UK has remained steadfastly around only 2% (Department for Transport [DfT], 2018a). By using documentary analysis of the available official policy documents and statements, the aim of this paper is to make sense of the policies that have been published concerning active travel (AT) in England. This is done from a figurational sociological perspective. Three key themes emerge from the analysis: (1) the rhetorical, advisory level of the vast majority of the policies; (2) the reliance on a wide network of local authorities to implement AT policy; and (3) the focus placed on individuals to change their behaviour. Furthermore, the analysis reveals that despite a large number of policy publications from a range of government departments claiming to promote AT, little has actually changed in this time period in terms of a national agenda. Despite the successive policies, it seems there is little appetite on behalf of recent governments to make widespread infrastructural changes, where instead the focus has largely been on persuading the individual to seek more active modes of travel, increasingly for their own, individual 'health' gains. Highlights •The paper is based on documentary analysis of available official policy documents from UK government on active travel since 1996 • The findings reveal the largely rhetorical, advisory level of the vast majority of the policies, which contributes to a lack of overall success in promoting active travel • The lack of success is compounded further by a reliance on a wide network of local authorities to implement active travel policy, when most local authorities appear more concerned with transport issues related to motorised vehicles • The findings reveal that active travel policy has becoming increasingly focussed on health gains that might be made from increasing the number of trips made by bicycle • The overwhelming focus of the policy documents analysed, however, is on encouraging individuals to change their behaviour, a process regarded as 'healthism', and one most sociologists of health suggest is likely to fail as a result • We conclude by suggesting that if the government is serious about wanting to see a 'step change' in the way in which people travel, particularly over shorter distances, then there is a need to have a more forceful approach to implementing policy within local authorities at the same time as making more substantial infrastructure changes to encourage cycling [ABSTRACT FROM AUTHOR]

The decommissioning of a health‐care service is invariably a highly complex and contentious process which faces many implementation challenges. There has been little specific theorisation of this phenomena, although insights can be transferred from wider literatures on policy implementation and change processes. In this paper, we present findings from empirical case studies of three decommissioning processes initiated in the English National Health Service. We apply Levine's (1979, Public Administration Review, 39(2), 179–183) typology of decommissioning drivers and insights from the empirical literature on pluralistic health‐care contexts, complex change processes and institutional constraints. Data include interviews, non‐participant observation and documents analysis. Alongside familiar patterns of pluralism and political partisanship, our results suggest the important role played by institutional factors in determining the outcome of decommissioning processes and in particular the prior requirement of political vulnerability for services to be successfully closed. Factors linked to the extent of such vulnerability include the scale of the proposed changes and extent to which they are supported at the macrolevel. [ABSTRACT FROM AUTHOR]

Background and Aim: Public health policy development is subject to a range of stakeholders presenting their arguments to influence opinion on the best options for policy action. This paper compares stakeholders' positions in the discourse networks of two pricing policy debates in the United Kingdom: minimum unit pricing for alcohol (MUP) and the soft drinks industry levy (SDIL). Design Discourse analysis was combined with network visualization to create representations of stakeholders' positions across the two policy debates as they were represented in 11 national UK newspapers. Setting: United Kingdom. Observations: For the MUP debate 1924 statements by 152 people from 87 organizations were coded from 348 articles. For the SDIL debate 3883 statements by 214 people from 175 organizations were coded from 511 articles. Measurements Network analysis techniques were used to identify robust argumentative similarities and maximize the identification of network structures. Network measures of size, connectedness and cohesion were used to compare discourse networks. Findings The networks for both pricing debates involve a similar range of stakeholder types and form clusters representing policy discourse coalitions. The SDIL network is larger than the MUP network, particularly the proponents' cluster, with more than three times as many stakeholders. Both networks have tight clusters of manufacturers, think‐tanks and commercial analysts in the opponents' coalition. Public health stakeholders appear in both networks, but no health charity or advocacy group is common to both. Conclusion: A comparison of the discourse in the UK press during the policy development processes for minimum unit pricing for alcohol and the soft drinks industry levy suggests greater cross‐sector collaboration among policy opponents than proponents. [ABSTRACT FROM AUTHOR]

Background: Due to an increasingly elderly population, a higher incidence of chronic diseases and higher expectations regarding public service provision, healthcare services are under increasing strain to cut costs while maintaining quality. The importance of promoting systems of co-produced health between stakeholders has gained considerable traction both in the literature and in public sector policy debates. This study provides a comprehensive map of the extant literature and identifies the main themes and future research needs.Methods: A quantitative bibliometric analysis was carried out consisting of a performance analysis, science mapping, and a scientific collaboration analysis. Web of Science (WoS) was chosen to extract the dataset; the search was refined by language, i.e. English, and type of publication, i.e. journal academic articles and reviews. No time limitation was selected.Results: The dataset is made up of 295 papers ranging from 1994 to May 2019. The analysis highlighted an annual percentage growth rate in the topic of co-production of about 25%. The articles retrieved are split between 1225 authors and 148 sources. This fragmentation was confirmed by the collaboration analysis, which revealed very few long-lasting collaborations. The scientific production is geographically polarised within the EU and Anglo-Saxon countries, with the United Kingdom playing a central role. The intellectual structure consists of three main areas: public administration and management, service management and knowledge translation literature. The co-word analysis confirms the relatively low scientific maturity of co-production applied to health services. It shows few well-developed and central terms, which refer to traditional areas of co-production (e.g. public health, social care), and some emerging themes related to social and health phenomena (e.g. the elderly and chronic diseases), the use of technologies, and the recent patient-centred approach to care (patient involvement/engagement).Conclusions: The field is still far from being mature. Empirical practices, especially regarding co-delivery and co-management as well as the evaluation of their real impacts on providers and on patients are lacking and should be more widely investigated. [ABSTRACT FROM AUTHOR]

Street‐level bureaucracy is an increasingly useful way to understand how strategic policy is implemented in day‐to‐day practice. This approach has uncovered the ways that individual health and social care practitioners work within institutional constraints to influence policy implementation at the micro‐level. Nonetheless, despite the diversity of settings where these street‐level bureaucrats (SLBs) work, little attention has been focused on the impact of place on policy delivery. This paper draws on empirical research to examine the ways that delivering government domestic abuse policy in the intimate space of the family home shapes the delivery of strategic policy in the everyday. Drawing on qualitative research with Health Visitors (HVs) in the UK in 2016, the study findings illuminate the ways that the material, socio‐spatial and idealised boundaries of the family home shape the implementation of policy. Key themes in the HV's narratives emerged as they described themselves as both a danger and in danger in the family home. In challenging the ontological security of the home (Giddens 1990) – privacy, security and control are key concepts here – HVs described how they shape their actions to achieve policy outcomes while simultaneously managing threats to the home, to professional identity and to self. [ABSTRACT FROM AUTHOR]

This paper aims to illustrate the tension between public health and civil liberties through the case study of the UK government's emergency response to the Covid-19 pandemic. In the area of public health, this tension is predominantly approached by reference to two theories: liberalism and communitarianism. This paper studies these positions and how they are manifested in evidence-based policymaking by combining a study of public health policy with a study of public health ethics. The studies help demonstrate the UK government's framing of health policy relating to Covid-19 in terms of liberalism and communitarianism. The paper concludes that in the initial UK government response to Covid-19, the government discourse evoked communitarian values and framed its policies as being evidence-led and as prioritising public health. However, the policy measures themselves manifested liberal values: they had the underlying concern of not infringing excessively on civil liberties, and individuals were given autonomy of decision making within the measures that were taken. The article concluded that emergency times require a communitarian response based on preventative action. This article is the first to combine public health policy with public health ethics to demonstrate how values form a key part of decision making. [ABSTRACT FROM AUTHOR]

This paper addresses policy change in Britain since 2010 across the three fields of domestic welfare, migration and asylum, and analyses the association between welfare, conditionality and control through the lens of civic stratification. Drawing on the work of Richard Munch and Mary Douglas, it moves beyond existing literature in this area to show that the more complex the classification in play, and the more severe its boundary implications, the more likely the emergence of contestable margins. Informed by Munch's 'battlefield' approach, it provides a discussion of contestable margins in each of the three policy fields and outlines the nature and source of challenges that emerge within the 'institutional battlefield'. A concluding section reflects on what is revealed by viewing welfare, migration and asylum within the same conceptual frame, identifying an emergent welfare paradigm that displays recurrent problems across all three fields. [ABSTRACT FROM AUTHOR]

This paper provides a personal memoir of historical work at the Addiction Research Unit, in particular the genesis of the book Opium and the People. This topic had policy significance for US drug policy and a competing US study was funded. The development of the substance use history field is surveyed, and its expansion in recent times through a focused professional association and a critical mass of researchers in the area, covering a wide range of topics. The politics of using history in this area can be problematic. History now sits at the policy table more easily, but there is still a tendency for professionals in the field to use (and misuse) it, rather than calling on the interpretive and challenging approach they would obtain from professional historians. The paper calls for historians and others to move beyond a substance specific focus and to avoid the tendency for 'naive history' implicit in using only digitized industry archives as the sole source. [ABSTRACT FROM AUTHOR]

Long-range temporal choices are built into contemporary policy-making, with policy decisions having consequences that play out across generations. Decisions are made on behalf of the public who are assumed to give much greater weight to their welfare than to the welfare of future generations. The paper investigates this assumption. It briefly discusses evidence from sociological and economic studies before reporting the findings of a British survey of people's intergenerational time preferences based on a representative sample of nearly 10,000 respondents. Questions focused on two sets of policies: (i) health policies to save lives and (ii) environmental policies to protect against floods that would severely damage homes, businesses and other infrastructure. For both sets of policies, participants were offered a choice of three policy options, each bringing greater or lesser benefits to their, their children's and their grandchildren's generations. For both saving lives and protecting against floods, only a minority selected the policy that most benefited their generation; the majority selected policies bringing equal or greater benefits to future generations. Our study raises questions about a core assumption of standard economic evaluation, pointing instead to concern for future generations as a value that many people hold in common. [ABSTRACT FROM AUTHOR]

Abstract The rise in chronic illness and comorbidity in Western society has resulted in an increasing emphasis on self-care initiatives. In the United Kingdom this is exemplified by the Expert Patient policy. This paper discusses the Expert Patient initiative as an example of the State’s third way approach to public health. The extent to which this policy challenges conventional power relationships between professional and patient, and fosters equal partnership is examined. In particular, how expert is defined and whether a professional understanding of the term is reconcilable with a patient’s expertise is debated. The paper argues that the Expert Patient initiative is unlikely to reconstruct chronic illness and may further complicate the State’s responsibility in meeting the needs of those with chronic illness. Issues of power within self-care are explored to illuminate the policy, and this paper argues that the Expert Patient initiative is an example of Foucault’s notion of pastoral power. Although the Expert Patient policy focuses on the rights and responsibilities of those with chronic illness, this paper concludes that there is no corresponding strategy to challenge professionals’ assumptions toward those with chronic illness. [ABSTRACT FROM AUTHOR]

This paper describes the political origins of the National Treatment Outcomes Research Study (NTORS) and the outputs and impacts of the study. NTORS was designed to meet the request of the Health Secretary and of a Government Task Force for evidence about the effectiveness of the national addiction treatment services. NTORS was a prospective cohort study which investigated outcomes over a 5-year period of drug users admitted to four major treatment modalities: in-patient treatment, residential rehabilitation, methadone reduction and methadone maintenance programmes. The study investigated treatments delivered under day-to-day operating conditions. Outcomes showed substantial reductions in illicit drug use and reduced injecting risk behaviours. These changes were accompanied by improved psychological and physical health and by reductions in criminal behaviour. However, not all outcomes were so positive. There was a continuing mortality rate in the cohort of about 1% per year, and many clients continued to drink heavily throughout the 5-year follow-up. NTORS findings informed and influenced UK addiction treatment policy both at the time and subsequently. The findings were influential in supporting an immediate increase in funding for treatment, and Government Ministers have repeatedly cited NTORS as evidence of the effectiveness of addiction treatment. One finding that received political attention was that of the cost savings provided by treatment through reductions in crime. This important finding led to an unanticipated consequence of NTORS; namely, the greater focus on crime reduction that has increasingly been promoted as a political and social priority for drug misuse treatment. [ABSTRACT FROM AUTHOR]

Griffith Edwards played an important role in cannabis policy debates within government advisory committees in the United Kingdom from the early 1970s until the early 1980s. This has largely been hidden from public knowledge by the confidentiality of these committee discussions. The purpose of this paper is to use Griffith's writings and the results of recent historical scholarship to outline the views he expressed, the reasons he gave for them, and to provide a brief assessment of his contribution to the development of British cannabis policy. [ABSTRACT FROM AUTHOR]

Key actors engaged in debate on obesity in Australia and the UK subscribe to radically different narratives about the nature, extent and even existence of this public health problem. Yet there is a common thread to these clashing narratives: evidence. All are emphatic that their story is 'evidence-based'. In this paper, I seek to examine this state of affairs by looking at how actors think about, use and interpret evidence across a range of sites of policy debate on this issue. In doing so, I contribute to academic inquiry about the place of evidence in democratic deliberation. Firstly, I find that there is a high degree of consensus among actors who promote differing interpretations of the issue on what evidence means and entails in the abstract. Secondly, I find that the differing narratives on obesity are underpinned by different interpretations of the evidence, but that internal inconsistencies affect each of these competing narratives as well. As such, I argue that policy actors should not be seen just as strategically marshalling convenient evidence to support a preconceived cause. Overall, I suggest that these findings have mixed implications for democratic deliberation on the issue, enhancing the deliberative side of the equation but undermining the democratic. I then point to ways in which the goals of evidence-based and democratic policymaking on this issue may be further reconciled. [ABSTRACT FROM AUTHOR]

Drawing on research investigating the impact of health imperatives around obesity, diet and exercise on the actions of teachers and pupils in schools, this paper offers a reflexive account of the relationships between the 'noise' of obesity discourse in the public domain, policies forged to tackle health issues and the realities of teaching in schools. Our analyses suggest that intersections of bio-policies, body pedagogies and human agents forge assemblages of meaning that frame and regulate but cannot determine either teachers' or young people's lives. Teachers and pupils experience the capriciousness of policies as they flow through specific school contexts and intersect with 'local' institutional cultures, expectations and interests. We suggest that Basil Bernstein's concepts and poststructural social theory prove useful when addressing how the aforementioned processes are emplaced, enacted and embodied. [ABSTRACT FROM AUTHOR]

In 2007, the English Department of Health (DH) issued advice stating 'pregnant woman' and 'those trying to conceive' should abstain from drinking alcohol. As others have noted, this advice was issued despite their being no new evidence about the deleterious effects of low levels of alcohol consumption. In this paper, we argue this development is significant for the social construction of 'risk', since in advocating abstinence without an evidence base for this advice, policy makers formalise a connection between uncertainty and danger. We suggest this development has important implications, most obviously for pregnant women, certainly impacting on the nature of the advice they will now receive and likely more generally on their experience of the transition to motherhood. We suggest it has wider implications for individuals' experience also, as policy makers appear to be advocating the same approach to risk to non-pregnant people. Further, it suggests a noteworthy formalisation of a new definition of risk, which should be debated far more extensively, as it matters for the future development of health policy. [ABSTRACT FROM AUTHOR]

In recent years, the English NHS has achieved substantial reductions in waiting times for hospital treatment. This paper considers first whether the data used by the Government provide an accurate description of changes in waiting times and identifies some of the limitations of the measures used. It then attempts to identify how reductions have been achieved. It argues that some features of central government policy have been important - such as the use of targets - others, such as the introduction of new private sector capacity have not. It also shows that changes at local level have been critical to achieving the recorded improvements, but the precise impact of these is hard to identify. [ABSTRACT FROM AUTHOR]

Public health policy has arguably taken a new direction in the UK since 1997. This is typified by a review of the public health workforce. A key profession within this workforce is that of health visiting. Starting Well, a Scottish National Health Demonstration Project is one attempt to develop the public health role of health visitors. The project aimed to improve child health by providing intensive home visiting to families in Glasgow. This paper reports on a process study focused on whether Starting Well, an intervention exemplifying contemporary public health policy, could be operationalised through health visiting practice. Semi-structured interviews were conducted with a purposive sample of 44 staff responsible for developing and implementing the programme. Whilst greater contact with families allowed health visitors to develop their understanding of the life circumstances of their case-load families, the evaluation raised issues about the feasibility of systematically changing practice and demonstrated the difficulties of implementing an approach that relied as much on individual values and organisational context as formal guidelines and standardised tools. Furthermore, the ability of the systems and structures within which practitioners were operating to facilitate a broad public health approach was limited. The policy context for public health demands that increasing numbers of health workers are familiar with its principles and modus operandi. It remains, however, a contested area of work and its implementation requires change at a number of levels. This has implications for current policy assumptions about improving population health. [Copyright &y& Elsevier]

Introduction: Nursing has come to play a prominent role in government health policy since 1997. Extending the scope of nursing practice into activities previously carried out by doctors can assist a managerialist and 'modernizing' project of increasing National Health Service (NHS) efficiency by removing demarcations between professional groups. Methods: Drawing on elements of poststructuralist linguistics, this paper presents an analysis of a key government speech in the context of a discussion of overall policy intentions. Results: The speech can be seen as an example of how government has attempted to use rhetoric to make its goals attractive to nurses. Conclusion: Policy-makers have to make their policies acceptable to those whom they expect to implement them. In this case, organizational efficiency, chiefly in terms of broader access to NHS services, as well as role substitution, is aligned with government policy promoting social enterprise and 'sold' to the nursing profession as enhancing its status compared with medicine. [ABSTRACT FROM AUTHOR]

Recent UK health policy initiatives promote a ‘no blame culture’ and learning from adverse events to enhance patient safety in the NHS. Similar initiatives exist in the USA and Australia. Changing the ‘blame culture’ in the NHS has been advocated in policy documents and inquiry reports for over a decade. Some key concepts that are used in the policy discourse –‘blame’; mistakes, errors and misdemeanours; and ‘culture’– are examined and considered in the light of pertinent social science literature to question some of the assumptions concerning these terms in the policy discourse, and to suggest some alternative questions and perspectives. The Three Inquiries, a recent series of statutory inquiries held in the UK, are used as a case study to explore some of the intra- and inter-professional difficulties of reporting errors and misconduct by medical practitioners. The paper offers an interpretive social science perspective as an alternative to more policy oriented and managerial approaches to patient safety issues, focusing on deeper structural aspects of organisational phenomena implicated in the ability or otherwise of medical and other healthcare staff to report mistakes and misconduct as one aspect of patient safety. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine the effects of health care policy on the development of integrated mental health services in England. Data sources: Drawing largely from a narrative review of the literature on adult mental health services published between January 1997 and February 2003 undertaken by the authors, we discuss three case studies of integrated care within primary care, secondary care and across the primary/secondary interface for people with serious mental illness. Conclusion: We suggest that while the central thrust of a raft of recent Government policies in England has been towards integration of different parts of the health care system, policy waterfalls and implementation failures, the adoption of ideas before they have been thoroughly tried and tested, a lack of clarity over roles and responsibilities and poor communication have led to an integration rhetoric/reality gap in practice. This has particular implications for people with serious mental health problems. Discussion: We conclude with suggestions for strategies that may facilitate more integrated working. [ABSTRACT FROM AUTHOR]

Cancer is a major cause of death and ill health, accounting for roughly one in four deaths in the UK. Concern with cancer services was expressed in the 1990s when it was reported that the quality of cancer care was patchy and variable, and clinical outcomes varied in different parts of the country. The Calman-Hine Report (1995) produced specific recommendations for the reorganizing and reconfiguring of cancer services, but although the Conservative government, which commissioned the report, endorsed its suggestions no additional funding was provided to implement the proposed changes, and consequently there remained variations in provision across geographical areas and between patients with different cancer types. However, since 1997 the Labour government has targeted cancer, appointing a Cancer Tsar, announcing a package of measures to“fight the war against cancer”, including the publication of a) and with Tony Blair pledging to end the postcode lottery for cancer treatment. This paper explores the concept of the“postcode lottery of cancer care”, why it exists and whether measures taken since the Calman-Hine Report and the Cancer Plan will address it. [ABSTRACT FROM AUTHOR]

A new Labour government was elected in the UK in May 1997 with a strongly stated commitment to improving public health and tackling inequalities. This focus on public health was part of a concerted attempt to tackle poverty and social exclusion through 'joined up thinking' across central government. Thus health inequalities were to be tackled 'upstream' through wider government initiatives. Fundamental to the government's policy has been the development of public health capacity, including a more multi-disciplinary public health workforce and greater partnership working at local level. Improving public health is a long-term project, however, and politicians' decisions are often driven by short-term election cycles. Midway into its first term, the government published The NHS Plan which re-focused policy attention on the problems of the health care system. As the 2001 election approached, the government launched Shifting the Balance of Power, a major re-organization of the English NHS with the intention of improving the 'delivery' of health care, but which also had profound implications for the public health function. This paper argues that UK government policy towards public health has been characterized by continuing and fundamental tensions. Far from empowering public health practitioners, these tensions in central policy have contributed to practitioners' uncertainty about their roles, and how they can meet the centre's increasing demands for demonstrable 'delivery'. The implications are considered for building capacity in the UK and for a wider systems understanding of capacity issues. [ABSTRACT FROM AUTHOR]

In this paper two disparate areas of social science theory, actor–network theory and policy networks, will be brought to bear on the problem of explaining the rapid development of an area of medical science and health policy in the UK. There has been a surge of interest in the treatment and management of personality disorder from within both the psychiatric profession and government ministries, and particularly those personality disorders deemed to be severe or dangerous. This has resulted in the development of a new psychiatric classification, the ‘dangerous and severe personality disorder’ (DSPD), and the funding and development of a new service to deal with it. Major new mental health legislation has been set in train to provide legal backing for the pre–emptive detention of patients with such a diagnosis, despite widespread uncertainty over its status, reliability or predictive capability. In the process of presenting and analysing this development, actor–network theory and policy networks will themselves be reviewed and compared, and common and incompatible elements, foci and mechanisms identified. [ABSTRACT FROM AUTHOR]

While there are important differences between the public health policies of Conservative governments of the 1980s and 90s and the current British Labour government a significant element of continuity is the emphasis on government facilitating informed choice by consumers as a key public health objective. The article considers such approaches to disclosure of health risks with respect to policy on the regulation of smoking. It argues that regulation, in this area, under the Conservatives has not served to ‘empower’ consumers and that such regulatory weaknesses appear to be replicated under its successor. Defects in regulation are traced with respect to disclosure of information on tar and nicotine ‘yields’; and cigarette design with respect to tip ventilation and the use of additives to increase nicotine delivery. It is argued that lack of disclosure and insufficient controls on the industry have led to consumers being misled concerning the relative risks of different types of cigarette. Equally, it is also likely that such deficiencies have enabled manufacturers to represent some cigarette types as ‘safe’. The paper concludes by arguing that, while the weaknesses of the current regulatory regime suggest the need for measures of increased disclosure and control of product design, there is also an unresolved tension as to whether ‘empowerment’ is an intrinsic goal of policy or a means to the achievement of public health targets. [ABSTRACT FROM AUTHOR]

This paper examines the right to health care. Various expressions of this right may be distinguished. These include both individual rights and social rights which could be based upon international treaties and constitutional rights. They may be found in national health legislation and, in some cases, in jurisprudence. To analyze the consequences of limiting the right to health care, a framework for judicial review has been developed which encompasses these expressions of the right to health care. The framework was used to examine legal and health policy developments in three Western and two Eastern European countries. In Italy and the Netherlands the right to health care is protected constitutionally (but on differing legal bases) while the United Kingdom does not have a written constitution. In contrast, Hungary and Poland have for many years seen the state take responsible for the provision, administration and allocation of health care services and the right to health care was guaranteed theoretically but not in practice because of the lack of (financial) means. However, the Polish Constitution explicitly anticipates possible limitations of the right to health care. What all these countries have in common is a cost containment perspective where the future will bring even tighter limits on what resources patients may consume. Despite differences in legal structure between these countries, where they seem to converge is on the consequences of putting limitations on the right to health care. The courts in Italy, the Netherlands and the UK have formulated conditions drawn from the acceptance that this right has to be judged within the context of limited resources. It may be concluded that finding a compromise between the right to health care and cost containment policies could also be an issue, Eastern European countries will have to face in the future. [ABSTRACT FROM AUTHOR]

Some years ago the Government set out their plans for the regulation of Nurses and other health professionals in The NHS Plan (Department of Health [DH], 2000) and Making a Difference (DH, 1999). This year the government produced a new series of White Papers, aimed at bringing to fruition the earlier plans and the ideology that underpinned them. This article considers two such papers -- neither produced by a nurse, despite their impact on nursing work. High Quality Care for All (DH, 2008a) and A High quality Workforce (DH, 2008b) are discussed considering the power and control of health care delivery that doctors and nurses now enjoy. A conclusion is reached that whereas there is much talk of innovations in nursing ideology and clinical practice, and significant advances in nurse education and training designed to facilitate advanced and autonomous practice within the nursing profession, it is just that. The real positions of power and influence within clinical provision and practice have remained the same: held by civil servants and members of the medical profession. While nurses are represented it is at a lower level of influence and they are missing from the top table. The political level of decision making for Healthcare directly involves members of the medical profession but not nurses. [ABSTRACT FROM AUTHOR]