Auditing power and policy in UK mental health services

This article summarises research that explored the way that policy has worked in UK mental health services over the last 20 years. It constructs a framework for analysing three stages of policy making, namely: policy initiation, policy formulation and policy implementation. Three levels of policy activity are also identified; these are located at the macro, national, level; the meso, district health authority level; and the micro, provider level. A matrix is then built up that facilitates an exploration of policy activity within and between these stages and levels. The main findings of the study were that, historically, no level has held a monopoly on power or influence in the policy process, that the hitherto unsung role of the meso level has been crucial for policy success and that managers’ abilities to shape their organisation decline above the meso level. Since the Labour Government came to power in 1997, however, the macro level has begun to dominate the policy process. The ensuing “top down” approach to policy formulation is encouraging uniformity of service, but may be stifling creativity. Policy activity is becoming less than the sum of its parts.