It is always good to see a second edition of a leading text. This book is a fully updated version of the 2007 edition, which was part of the ‘Understanding Welfare’ series by Policy Press. Like the first edition, this book does ‘what it says on the tin’, clearly fulfilling the series aims of presenting topical and innovative approaches to understanding issues by leading experts with accessible texts.
Chapter 1 reviews conceptual frameworks that are useful in the study of health policy. Chapters 2–4 (and 7) cover similar ground to UK health policy texts, albeit with a different structure, and with a significant amount of detail and many useful examples: party politics and health policy; central government and health policy; and parliament and health policy. Chapter 5 focuses on the media and health policy. Chapter 6 explores policy networks and health policy. Chapter 7 examines health policy and the NHS (structure and organisation; priorities and planning; leadership and management; regulation; financial incentives and incentives; and culture and networks). Chapter 8 looks at partnerships and health policy. Chapter 9 introduces a welcome perspective on health policy in Scotland, Wales and Northern Ireland, while chapter 10 widens this to cover the international context of UK health policy.
On its own terms, this material is comprehensive, clear and well presented, as would be expected from a leading health policy analyst. It includes many student friendly devices such as overviews; boxes; summaries and key questions (but where are the answers?), and perhaps the best and most overlooked student friendly device of clear exposition. It contains an extensive bibliography. It tells you not quite everything but most of what you want to know about understanding (UK) health policy, and Baggott is an excellent guide to the familiar and less familiar corners of the NHS. Of course, there are some minor quibbles. For example, the material on networks and partnerships could have been more clearly linked. In my view, ‘learning lessons from elsewhere’ deserves more than just over two pages, and requires more stress on policy learning and transfer. Perhaps more is needed on ‘medical tourism’ and international workforce migration. Surely the claim that the Transatlantic Trade and Investment Partnership (TTIP), possibly one of the most significant influences on the future of NHS ‘may be bad for health’ (p. 244) deserves more than a paragraph?
It is generally a little unfair to criticise a work by outlining the book that the reviewer would have written. However, in my view, it is not fully clear what health policy we are understanding and in what ways. For me, it falls a little ‘betwixt and between’. It is not a UK health policy book, which is a very crowded market with texts in their sixth and seventh edition, and Baggott's own excellent text in its third edition (although curiously not updated since 2004). Neither is it a book applying policy analysis to health (e.g. Alaszewski and Brown, Reference Alaszewski and Brown2011; Buse et al., Reference Buse, Mays and Walt2012). Rather it is a policy book focusing on UK health policy, which is perhaps a little too UK (or for nine of its eleven chapters, England) centric, with many students following health policy courses from outside the UK.
Chapter 1 introduces conceptual frameworks: policy as a rational, hierarchical process; centralisation and decentralisation (implementation); partnerships and collaboration; policy, ideology and political parties; interests (chapter 6); institutions and agendas (chapter 7); and policy as an adaptive, learning process. I am not sure that this chapter contains the conceptual foundations to support the remainder of the book. There is very little on ideas. There is only one model of agenda setting. I am not sure that the media deserves a whole chapter, and would have preferred to see this material within a more detailed treatment of interest groups. Conversely, there is insufficient stress on implementation and evaluation, and material on topics such as implementation and accountability is scattered throughout the text. For example, the index shows that accountability features on some 38 pages, but there is no section with focused material.
For all the criticism aimed at it, I feel that the ‘stages’ model (p. 3) provides the clearest heuristic approach to the study of health policy. For me, the text has too much of the feel of a ‘traditional public administration’ text (e.g. party politics; central government; parliament) which is based on particular assumptions. For example, it could be argued that party differences in health policy are now based more on minor discursive skirmishes (e.g. favouring more ‘private involvement’ but not ‘privatisation’) rather than the pitched battles from the earlier years of the NHS. In my view, the perspectives of major writers such as Katherine Thelen, Jacob Hacker and Daniel Beland are missing from the bibliography, and important texts (e.g. on implementation by Michael Hill and Peter Hupe, and on the policy process by Paul Sabatier, are cited in their original rather than revised editions). Although this is a valuable text, it cannot be ‘the’ sole recommended text for the MSc courses that I teach. Perhaps my preferred framework of a clearer link between policy stages and health policy material may be better suited to postgraduate rather than undergraduate courses, but in my view Baggott has missed an opportunity to create the leading text and primary guide to understanding health policy that he is ideally placed to deliver.
