Knit your own without a pattern: Health promotion specialists in an internal market

Abstract

The reforms of the National Health Service in England have given an emphasis to ''strategic'' approaches to health and health care, in that, ideally, purchasing decisions will be made on the basis of evidence from various forms of ''needs assessment''. Alongside these reforms a strategic approach to the promotion of health has been set out in the ''Health of the Nation'' (DoH 1992). However, although the promotion of health is high on the policy agenda, the occupational group of health promotion specialists, whose prime function it is to devise, develop and implement health promotion strategies, have been ignored. Drawing on qualitative interview data with these specialists in both provider and purchasing settings in England this paper argues that thus far the reforms have actually hindered the development of a strategic approach to the promotion of health by health promotion specialists. Three main reasons for this are suggested; a confusion over the most appropriate institutional location for health promotion specialists; a lack of clarity by key actors as to the role and function of health promotion specialists; and the emergence of a model of effectiveness and efficiency which is largely antithetical to the philosophy and practice of health promotion.