Independent experts? An in-depth case study of how think tanks work to shape heath reform in England

A combination of weak political institutions and a tendency for the state to generate less technocratic knowledge has opened up new spaces in which a range of ‘policy experts’ seek to shape the business of government... [ view full abstract ]

A combination of weak political institutions and a tendency for the state to generate less technocratic knowledge has opened up new spaces in which a range of ‘policy experts’ seek to shape the business of government (Medvetz 2008). Think tanks have sought to occupy these spaces by offering policy analysis and expertise in a number of areas, including healthcare. This expertise tends to be presented as independent, value-neutral expertise that can inform policy in a simple and direct way. However, there is growing concern about the role that think tanks play in debate and in promoting particular approaches to planning, delivering and managing healthcare (Lakoff 2011, Player and Lees 2011).

To-date there have been few studies that question how think tanks operate in health care. Drawing on a case study of think tanks in England that have sought to influence health reform, I examine what ‘independence’ means in the context of recent health policy, and how it is performed by think tanks. I present an interpretive policy analysis of data collected from four think tanks, combining an auto-ethnographic account of working as a senior member of staff in a think tank with analysis of 30 documents and 14 interviews with senior think tank representatives. My analysis is informed by field theory, practice theory and discourse theory (Shaw et al, 2014). I pay particular attention to the central role that language plays in framing the work that think tanks do.

My findings demonstrate how think tanks (and the ‘experts’ allied to them) seek to position themselves as an ‘independent research organisation’ or ‘charitable research foundation’, emphasising a range of knowledge-related activities (e.g. journal articles), artefacts (e.g. websites), actors (e.g. visiting academics), settings (e.g. meeting rooms) and instrumental language (e.g. ‘evidence-based’) that, they say, allow them to feed emerging evidence into policy and so improve health services. Such positioning provides them with legitimacy in the eyes of decision-makers (who work with a similar conception of policy making), but also works to obscure the interests, values and beliefs represented by think tanks. A parallel set of think tank activities (e.g. ‘behind the scenes’ meetings with politicians and civil servants) allows them to link with ‘like-minded’ actors and interests with a view to influencing health policy and shaping healthcare delivery in their own vision. We conclude by reflecting on the way in which think tank experts have shaped recent proposals to reform the English National Health Service, bringing together business, media and political interests in broad support of government proposals for extending competitive market principles and behaviour to the publicly-funded health service.

References

Lakoff G (2011) What conservatives really want. http://georgelakoff.com/2011/02/19/what-conservatives-really-want/.

Medvetz T (2008) Think Tanks as an Emergent Field. Social Science Research Council.

Player S and Leys C (2011) The Plot Against the NHS. Merlin Press Ltd.

Shaw SE, Russell J, Korica M and Greenhalgh T (2014) Thinking about think tanks in healthcare: a call for a new research agenda. Sociology of Health & Illness.