Introduction

This chapter discusses some of the key elements of health policy since 1997 and argues that there is a discrepancy between the appearance of health policy as presented by government during New Labour's period in office and the reality of its character and significance. New Labour's approach to communication has drawn considerable attention to the use of ‘spin’ in the management of party and governmental initiatives. Previous experience of damaging newspaper coverage, the 24-hour news media and the insecure position of the Labour Party electorally have all contributed to a discernible shift towards the more cautious and studied management of information about government policy in relation to different audiences or ‘publics’. No doubt the significant connections between New Labour and the public relations industry have further fuelled this drift (Dinan and Miller, 2007).

‘Spin’ can be understood as the defining and exposition of political issues in order to shape public understanding in a manner consistent with one's own interests, and can entail manipulation, ambiguity, euphemism and selective presentation. This chapter is not about the use of spin or the management of information per se but about how selected aspects of health policy have been developed and implemented without adequate democratic determination despite reiterated promises to give patients and public a greater say in the National Health Service (NHS).

Labour's record is worth examining because of two connected facts: first, the policies implemented in the NHS have been very radical, more far-reaching than at any previous point in the institution's 60-year history; and second, there has been relatively little public debate about these policies at a national level. This could well be taken as evidence that the public supports the government's reforms and considers them to be bringing about desired improvements. On the other hand, relative public silence, or even acquiescence, could be interpreted as reflecting a lack of understanding of the nature and long-term consequences of the reforms. Such a lack of understanding could result from a disengagement from politics, an uncritical trust in the government's stance or a lack of relevant information by which to make a judgement.