It is acknowledged that health technology assessment (HTA) is an inherently value-based activity that makes use of normative reasoning alongside empirical evidence. But the language used to conceptualise and articulate HTA's normative aspects is demonstrably unnuanced, imprecise, and inconsistently employed, undermining transparency and preventing proper scrutiny of the rationales on which decisions are based. This paper – developed through a cross-disciplinary collaboration of 24 researchers with expertise in healthcare priority-setting – seeks to address this problem by offering a clear definition of key terms and distinguishing between the types of normative commitment invoked during HTA, thus providing a novel conceptual framework for the articulation of reasoning. Through application to a hypothetical case, it is illustrated how this framework can operate as a practical tool through which HTA practitioners and policymakers can enhance the transparency and coherence of their decision-making, while enabling others to hold them more easily to account. The framework is offered as a starting point for further discussion amongst those with a desire to enhance the legitimacy and fairness of HTA by facilitating practical public reasoning, in which decisions are made on behalf of the public, in public view, through a chain of reasoning that withstands ethical scrutiny.

Using recently released papers, we analyze an attempted neoliberal policy revolution in 1980s Britain—the attempt to restrict the state pension to a minimal flat-rate benefit and supplement it with personal pensions. In the process, the government would abolish both the state earnings-related pension and collective employer-provided occupational pension schemes that then covered about half the workforce and owned about a quarter of all shares listed on the London Stock Exchange. Unusually, our focus is not primarily on ministers, as we unpick an attempted revolution that would have refashioned every worker in Britain as an investor-capitalist. Rather we focus on a sub-ministerial center of political power, the No. 10 Policy Unit, and the influence on it of the Centre for Policy Studies, a right-wing think tank. In doing so, we confirm the latter's importance as source of neoliberal ideas for the architects of policy change in the 1980s and reveal the centrality of the Policy Unit as a source of motive power for Britain's neoliberal revolution. We also, however, highlight the relative pragmatism of ministers as they backed away from the Policy Unit's attempted revolution, choosing instead to implement a more evolutionary set of reforms.

It is widely recognized that ‘the individual’ was prioritized by the Thatcher governments. However, there has been little analysis by historians of exactly how the Thatcher government conceptualized ‘the individual’. In this article, we attempt to remedy this deficiency by undertaking a case-study of a key Thatcherite social policy reform: the introduction of ‘personal pensions’. This approach allows us to understand the position of ‘the individual’ on the functional level of Thatcherite policy-making. In doing so, we argue that there was no coherent or fixed Thatcherite concept of the individual. Instead, we identify three fundamental tensions: (i) should individuals be capitalists or consumers; (ii) were they rational or irrational; and (iii) should they be risk-taking entrepreneurs or prudent savers? This reflected, in part, conflicts within the diverse tapestry of post-war neoliberal thought. We demonstrate in this article that these tensions undermined the Thatcher governments’ original attempt to create a society of entrepreneurial investor-capitalists, which in turn cemented their preference for simply maximizing individual freedom of choice within a competitive – yet tightly regulated – market environment.

In explaining Britain's post-war relative economic decline, contemporary historians have concentrated upon ‘government failure’: not enough, too much, or too much of the wrong sort of government intervention. Implicitly, such explanations conceive the British state as both centralized and powerful. Recent developments in political science have questioned this traditional view. Using this insight to structure its historical analysis, this article examines the wide array of policy changes that flowed from the British government's adoption in the early 1960s of an explicit target for higher growth. It finds that the principal reasons for the failure of these policies can be found in the fragmentation and interdependence of Britain's economic institutions – the source of which lay in the particular historical development of Britain's polity. These issues of governance required new conceptions of both policy making and policy implementation able either to strengthen the power of the centre to impose change, or to promote consensus building. However, lacking a sufficient shock to the system, and imprisoned in a mindset in which the British state was conceived as both centralized and powerful, elites saw little need for fundamental institutional change.