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Chapter 3 looks at Scotland in the United Kingdom to explore the relationship between nationalism and social policy. It explains how the relationship between British nation-building and social policy emerged during the post-war era and outlines the particular importance of this process in Scotland, which depended more upon social benefits than did the South of England. It then explores the mobilization process favouring devolution for Scotland in the context of social policy retrenchment, and shows how these two issues meshed during Thatcherism. Finally, it analyses the impact of devolution on social policy development in Scotland and in the United Kingdom at large. Although it is too early to draw definite conclusions about the nature and extent of this impact, it is clear that the institutional and political transformations involved in devolution have affected policy processes and outcomes.

This chapter outlines the theory of deliberative democracy and deliberative institutions, highlighting the legitimacy problems — to do with the scale of the deliberations and the motivation to participate — as experienced by the organizers of a citizens’ jury in Leicester, England, in 2000. It explains the approach and methods, outlines the argument, and summarizes five cases of deliberation in the UK’s National Health Service.

This chapter explores the context of the cases, setting out the history of patient involvement initiatives and deliberative experiments in the UK. It highlights the antipathy to interest groups and the ‘research orientation’ of those experiments, and the effects that orientation has had on limiting the scope and agenda of deliberation. It argues that whether deliberation occurs at the local level or at the centre matters a great deal, but that deliberative experiments tend to be at least as much about resource battles between the centre and the periphery as responding to citizens’ needs.

This chapter argues that the definition of rationality is a major source of disagreement over the legitimacy of decision making processes. It draws attention to battles over competing problem definitions and agendas as a means of controlling debate, and the failure of micro-deliberative processes to handle such battles. It identifies the rhetorical devices used by deliberators to persuade their external audiences, and the impact these have on the rationality of the process. It argues that the more decisive a process is, the more it will attract publicity and the more inclusive it will be, but also the greater the incentives are to act strategically.

This chapter discusses the historical role that GPs played in shaping the National Health Service (NHS), and with the reception of the NHS by doctors and their patients. The creation of the NHS led to substantive changes in the hospital sector and in specialist health services. But within general practice the major change was the extension of free-at-the-point-of-access health care to the whole population: to women and children as well as men, to the middle class as well as the working class. The standard of care and social ethos of the new health service was essentially a continuation of the old panel system.

This chapter discusses what has changed and what has remained the same in the National Health Service (NHS). It enumerates the crucial developments that have occurred in the NHS since 1997 and highlights key features of the development of consumerist rhetoric. The chapter also considers how changing times and policy initiatives impact on palliative care and how user involvement developed here. It concludes with a consideration of whether the new NHS constitutes an opportunity or a threat for the capacity of palliative care to maximize its achievements and overcome its challenges.

This chapter discusses the NICE and NSFs. NICE was established in April 1999 to increase efficiency in the National Health Service's (NHS) uptake of interventions that are both clinically and cost-effective; encourage more equitable access to healthcare; provide better and more rational use of available resources by focussing the provision of health care on the most cost-effective interventions; and encourage the creation of new and innovative technologies. NSFs were established at the same time as NICE as a complementary process to establish national standards and guidelines. NSFs are long-term strategies for improving specific areas of care to help ensure consistent access to services and quality of care right across the UK.

This chapter explores the story of the 1942 Beveridge Report and the beginnings of the welfare state. The policies proposed by Beveridge and the 1945–48 legislation were logical extensions of government's expanding role in social welfare policy beginning with the Liberal Welfare Reforms. This does not mean that the importance of the postwar legislation should be downplayed. Because of the adoption of the National Health Service, universal coverage, and equality of treatment, Britain after 1948 deserves to be called a welfare state, while Edwardian and interwar Britain do not. Unfortunately, despite the enthusiasm with which the public greeted the welfare state, the postwar policies did not eliminate economic insecurity.

This chapter translates social movement theory into an organizational change intervention designed to improve patient services. The paper describes how the authors' team from University College London came together with the English National Health Service (NHS) staff in a unique five‐year collaboration to apply social movement principles to the challenge of bringing about major healthcare reform. The collaboration went through five stages on its journey from concept to implementation: (1) an initial period of evidence gathering and literature review; (2) a series of conferences and workshops exploring the relevance and application of social movement ideas to healthcare reform; (3) field testing of change interventions within four pilot NHS organizations; (4) the launch of a revised model to a larger group of twelve NHS organizations with an identifiable “cause”; and (5) evaluation with a sample of those who attended events to ascertain what happened as they implemented plans. This chapter critically considers the relevance and utility of social movement theories for health practitioners, a comparison between the social movement lenses and organizational change theories commonly used by health providers, and discussion of practical issues arising during implementation of social movement activity within a large formal organization.