The Role of the Policy Process on Health Service Reconfigurations: Evidence, Path Dependency and Framing; Comment on “‘Attending to History’ in Major System Change in Healthcare in England: Specialist Cancer Surgery Service Reconfiguration”

Document Type : Commentary


King’s College London, London, UK


Historically healthcare services have largely developed on an incremental basis, with various piecemeal changes and some notable policy leaps that illustrate a punctuated equilibrium health policy process. More recently policy-makers have attempted, successfully and unsuccessfully, to reconfigure healthcare services to address perceived problems in the delivery of important services such as stroke, cancer, and trauma. Perry et al provide a welcome addition to research in this area by focusing on the importance of history in a reconfiguration of cancer services in Greater Manchester (GM). Perry et al analyse how and why this configuration was successful after several failed attempts in the past and in this commentary, I want to reflect on the explanatory role health policy analysis can contribute to studying the reconfiguration of healthcare services.


  1. Fraser A, Baeza JI, Boaz A. 'Holding the line': a qualitative study of the role of evidence in early phase decision-making in the reconfiguration of stroke services in London. Health Res Policy Syst. 2017;15(1):45. doi:1186/s12961-017-0207-7
  2. Perry C, Boaden RJ, Black GB, et al. "Attending to history" in major system change in healthcare in England: specialist cancer surgery service reconfiguration. Int J Health Policy Manag. 2022. doi:34172/ijhpm.2022.6389
  3. Best A, Greenhalgh T, Lewis S, Saul JE, Carroll S, Bitz J. Large-system transformation in health care: a realist review. Milbank Q. 2012;90(3):421-456. doi:1111/j.1468-0009.2012.00670.x
  4. Kingdon J. Agendas, Alternatives and Public Policy. 2nd ed. New York: Pearson; 2010.
  5. Laswell HD. Politics: Who Gets What, When, How. New York: Whittlesey House; 1936.
  6. Pierson P. Increasing returns, path dependence, and the study of politics. Am Polit Sci Rev. 2000;94(2):251-267. doi:2307/2586011
  7. Snow SJ. Health and Greater Manchester in historical perspective. Representation (McDougall Trust). 2015;51(4):439-452. doi:1080/00344893.2016.1165513
  8. Jones L, Exworthy M. Framing in policy processes: a case study from hospital planning in the National Health Service in England. Soc Sci Med. 2015;124:196-204. doi:1016/j.socscimed.2014.11.046
  9. Koon AD, Hawkins B, Mayhew SH. Framing and the health policy process: a scoping review. Health Policy Plan. 2016;31(6):801-816. doi:1093/heapol/czv128
  10. Carrier J, Kendall I. A policy perspective. London J Prim Care (Abingdon). 2008;1(1):45-47. doi:1080/17571472.2008.11493200
  11. Entman RM. Framing toward clarification of a fractured paradigm. J Commun. 1993;43(4):51-58. doi:1111/j.1460-2466.1993.tb01304.x
  12. Edelman M. Contestable categories and public opinion. Polit Commun. 1993;10(3):231-242. doi:1080/10584609.1993.9962981
  13. Baeza J. Restructuring the Medical Profession: The Intraprofessional Relations of Gps and Hospital Consultants. McGraw-Hill Education; 2005.
  14. Gale AH. I stuffed their mouths with gold part II. Mo Med. 2020;117(4):296-298.
  • Receive Date: 23 August 2022
  • Revise Date: 10 October 2022
  • Accept Date: 22 October 2022
  • First Publish Date: 23 October 2022