As soon as government policies are replaced by something new, they become fit subjects for academic study.
This book reviews the policies of the previous government in three fields: the health service, secondary education and socially rented housing.
The unifying theme of the book is decentralisation of management, and the authors analyse the impact of this on the various 'target' organisations - trust hospitals, in the case of the NHS - drawing out quite shrewdly both the intended benefits and potential drawbacks.
These analytical sections of the book, together with the brief historical overview, are generally good value.
Whenever the retrospectoscope is brought to bear, however, there is a temptation to use it to impose order where it did not exist previously, and this book does not always manage to remain immune. The notion that there was a unified theory of decentralisation driving all three policies is probably one example, and some of the description of implementation feels more pre-ordained than was apparent at the time.
The middle sections of the book describe the authors' study of four organisations in each of the three fields, and the conclusions they draw.
To preserve anonymity, the organisations are charmingly named after various species of the animal kingdom. In the case of the four trusts, these are birds (pigeon, starling, duck and eagle - presumably turkey, ostrich and dodo declined to take part). These sections feel slightly less convincing, at least in relation to the NHS.
This is perhaps because the conclusions lack any real surprises: trust freedoms were less than protagonists hoped for, the internal market was extremely constrained, but delegated authority resulted in the transformation of many hospital environments.
It is worth saying, however, that at each of the carefully selected organisations some 13 or 14 interviews were carried out and documents reviewed, and that all of this material was thoroughly and carefully assessed before conclusions were drawn. Therefore the conclusions have the merit of being based on more systematic evidence than is usual - although it is difficult to escape entirely the notion that some of the preconceived ideas of the interviewees may have come through the process unscathed to rest among the conclusions of the interviews.
There are one or two questionable assertions in the book. The authors believe that the lack of legal enforceability of service contracts was crucial in determining that there would be no 'true' internal market, whereas most NHS observers would, I think, point to the reluctance to allow any trusts to fail on what might be seen as commercial ground.
Equally, the concept of 'core services', highlighted once or twice in the text, actually disappeared at a very early stage when core and non- core services were found to be impossible to distinguish.
On the whole, however, this is an interesting and well-written account, well worth looking at for its external perspective on public sector management policy.
And the authors believe that there is a relevance to present policies, which they say represent political decentralisation in place of management decentralisation.
Bill Kirkup
Acting regional director of public
health, NHS Executive, Northern and Yorkshire region.
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