Has Labour decentralised the NHS? Terminological obfuscation and analytical confusion

This article considers the rise of decentralisation as an approach to public-sector reform generally, and its approach to the British National Health Service (NHS) specifically. It suggests that the term ‘decentralisation’ is often so poorly defined that reforms made in its name cannot be assessed to see if they have achieved it as a goal or not. The article explores the meanings of decentralisation and attempts to clarify it, before going on to examine, through a review of what four key commentators have said about it, how health reform under the British New Labour government, despite often claiming to be decentralising, has often been centralising instead. The article presents a framework for assessing claims of decentralisation in public reform more generally, before presenting a specific example from the NHS.