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2010 - Seventeenth International Conference of the Council for European Studies Pages: unavailable || Words: 8268 words || 
1. Smyrl, Marc. "Insiders, Outsiders, and Policy Change: Reforming Health Policy in France and Britain" Paper presented at the annual meeting of the Seventeenth International Conference of the Council for European Studies, Grand Plaza, Montreal, Canada, Apr 15, 2010 Online <PDF>. 2019-06-18 <>
Publication Type: Individual Paper
Review Method: Peer Reviewed
Abstract: Reform of the British NHS under the Blair and Brown governments has largely been the work of experts and advisors brought in from outside government for relatively brief tenures. Largely unconstrained by institutional inertia and vested interests, they have provided the programmatic substance that gave form to Blair’s political desire for significant and measurable change. Attempts to generalize this experience, however, would seem to be contradicted by the experience of France, in which changes of similar magnitude in national health policy have been brought about by a group of consummate insiders: long-serving senior civil servants. This paper argues that behind obvious differences in the socio-professional identity of actors at the source of programmatic change are deeper and far more significant similarities, and that comparison and generalization is indeed possible across these seemingly “most different” cases. The significant element of both cases is the ephemeral rise in both cases of a program-bearing collective actor possessing positional power resources, programmatic coherence, and a clear motive for prevailing in intra-elite competition for legitimate authority.

These observations, based on empirical research carried out from 2006 to 2009, invite us to revisit the theoretical bases underlying models of institutional change, looking beyond the notions of institutional equilibria, path dependence, and veto players. Understanding content requires an approach placing greater emphasis on the role of ephemeral collective actors as producers of the integrated policy programs that provide the positive component to programs of reform.

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