THE POLITICS OF MEDICAL REPRESENTATION: THE CASE OF THE BMA 1979 TO 1995

The British Medical Association (BMA) has traditionally been regarded as commanding considerable influence over health policy formulation throughout the post-war period. However, health policy analysts have more recently suggested a decline in BMA influence as a result of a hostile political environment since 1979. This thesis questions the premise for this argument and attempts to ascertain whether BMA influence over health policy formulation has in fact been eroded, to what extent and why. The existing literature pertaining to government/group intermediation and group influence over policy formulation is critically reviewed, including an examination of Grant's insider/outsider dichotomy, Dunleavy's ideological corporatism, Alford's structural interests model, Marsh and Rhode's policy networks model and Majone's model. These theories and models, often employed to facilitate an understanding of, and explanation for, pressure group influence over the policy process, invariably fail. Consequently, the thesis develops a theoretically eclectical approach to examining BMA influence which includes consideration of the multi-dimensional aspect of pressure group influence based on a three-dimensional interpretation of power. Case studies which reflect the complexity of the BMA are examined within an original framework of policy typologies sympathetic to the main areas of policy within which the BMA has demonstrated continuing influence. These areas relate to debates concerned with the regulation of the medical profession (Regulatory Policy), issues of a general public health and social welfare nature (Social Policy), issues related to the structure of health care delivery (Structural Policy), policy debates concerned with the interface between doctors and other health related professional groups and their respective occupational boundaries (Inter-Professional Policy), and, finally, issues related to medical terms and conditions of employment (Remuneratory Policy). Case studies are also employed to benchmark the BMA/government relationship prior to 1979. These include the creation of the General Medical Council, the creation of the NHS and the 1974/5 dispute over pay beds and consultant contracts. This analysis questions previous studies depicting the BMA as highly influential over health policy formulation and hence the degree of possible decline in BMA influence throughout the 1980s and early 1990s. BMA political influence is found to be the product of a dialectical relationship between factors exogenous as well as endogenous to the policy network. Whilst political, economic, ideological and social variables have a part to play in determining the outcome of policy debates, as important is the structure of the policy network and the resources of the actors within the network. In terms of a theoretical explanation of BMA influence the policy network model is argued to be the most illuminating but only if considered in tandem with Majone's model and a multi-dimensional concept of power. In order to understand the overall influence of a pressure group, its attempts to exert influence across the spectrum of policy debates in which it is engaged must also be acknowledged. This theoretical approach explains why BMA influence may have been perceived to have declined since 1979 but equally why there are important caveats within this overall generalisation. The extent to which there has been change in BMA influence differs within as well as between different policy sectors and whilst the BMA may have become more overtly politicised this does not necessarily equate with a decline in influence.

Name dc:type.qualificationname

PhD

Level dc:type.qualificationlevel

Doctoral

Grantor dc:publisher.institution

De Montfort University

Year dc:date.issued

1997

Author dc:creator

• MCGREGOR-RILEY, VICTORIA

Licence

• https://dora.dmu.ac.uk/bitstreams/71adf6d1-faf8-490b-87e1-12b1e0ecf8c9/download