Study Of Policy Making In Health Authorities: The Case Of The Employment And Special Health Needs Of Ethnic Minorities

This thesis will examine and analyse the process of policy making in health authorities. [It will draw on. existing work in this area and apply their approaches and conclusions to the issue of race relations policy development in, an inner London health authority. There have been very few studies of ow health authorities have responded practically and at a policy level to the presence of minority groups. A somewhat strange situation, given the growing interest in the interaction between racial identity, health experience and health ‘services. In attempting this analysis, this thesis has had to draw together some diverse issues that have been of concern to clinical researchers, epidemiologists, health professionals and voluntary groups to name but a few. This policy area was chosen principally because in practical terms the NHS seems to be out of step with all other major social services in its response to ethnic minorities. A slightly different version of this thesis is to be published in book form in early 1988 as 'Race and health policy’ (Croom Helm, Londen. My basic hypothesis is that theories of the way in which decisions and policies are made in local health authorities can be utilised to explore how race relations issues are handled locally. Moreover, since ethnic minority residence is highly concentrated, and race is seen as a matter for local rather than national action in Britain, race relations issues provide a further test of the ability of a nationally organised service to respond to local need; as well as a test of the nature of decision making in the NHS. In terms of policy development and implementation, I contend that it is the creation of networks and individuals committed to particular causes or ' products’ which are the motive force in policymaking at a local level. But this is not all there is to it: It seems to me from this research, that a further requirement is that there is some form ‘legitimate forum’ to provide the 'engine room of change’ within the organisation. This explains the significance given to the creation of committees or working parties in health authorities. Through this formal mechanism, committed individuals are recruited and the discussions and negotiations which ensue, assist in the shaping of the local policy agenda. However, substantive action is only possible if the policy is formally adopted in the management system, or if committed professionals of sufficient power and status take “executive action" within their area of responsibility, support the policy issue and carry their colleagues along with their conviction. It is argued that without this penetration and support of management and professional networks, policy making and, more particularly, innovation cannot succeed at a local level in the NHS.