Over the period covered by this book, between the late 1990s and 2012, health policy has been in a state of perpetual change. This is less true elsewhere in the UK than in England, where there has been a rapid succession of policy and organisational changes, initially under the Labour government (1997–2010) and then under the Coalition government (from 2010 to the present). In the other countries making up the UK, with the arrival of devolution at the close of the 1990s, the three countries (Wales, Scotland and Northern Ireland) have adopted different models and a different pace of change (for up-to-date reviews of health policy in each of the four UK countries see the ‘Health systems in transition’ reports from the European Observatory on Health Systems and Policies, Boyle, 2011; Longley et al, 2012; O’Neill et al, 2012; Steel and Cylus, 2012).

With the election of what turned out to be a Coalition government in May 2010, there was no expectation of major change in the health sector, as the Prime Minister, David Cameron, had publicly and explicitly ruled out further ‘top-down’ reorganisation of the NHS on the grounds that there had been quite enough of it already, much of which had failed to achieve its intended objectives. The Coalition agreement mentioned making Primary Care Trusts more democratic but there was no suggestion of a major wholesale restructuring affecting virtually every part of the NHS and public health. Nor did the government have a mandate from the electorate for major change since none had been proposed or considered during the election campaign. But it seems that the then Secretary of State for Health, Andrew Lansley, had different ideas and had in fact a plan for significant change in an advanced stage of readiness in the event that he would be in a position to unveil it and put it into operation.

Two White Papers published in 2012 set the scene for arguably the biggest change agenda in the history of both the NHS and public health (Hunter, 2011). The NHS White Paper was published in July 2010, barely two months after entering office (Secretary of State for Health, 2010a), with the public health White Paper following six months or so later (Secretary of State for Health, 2010b).