On the buzzword approach to policy formation.

This article draws attention to an absurd feature of contemporary political life that significantly affects health service policy and calls for an urgent explanation. Policies are formed by a process that privileges rhetoric over reality, producing policies that are conceptualized at a later date. Two influential articles on clinical governance illustrate this phenomenon perfectly. Lack of clarity about its true meaning and nature is a key feature of clinical governance. The lack of clarity allows policy-makers to shift responsibility for the problems of the health service onto the workforce, who are required to interpret the deliberately vague and platitudinous statements of management in order to implement the policy. But management, through the creation of monitoring agencies, reserves the right to determine whether the policy has been correctly interpreted, thus retaining power without responsibility. Government and senior management have abandoned the communicative function of language, eschewing reasoned debate (as characterized by the use of evidence and structured argument), instead employing language exclusively for the purposes of control and manipulation. Those of us still concerned that the future of our essential services should be determined by open and reasonable debate need to discuss urgently how to explain and respond to this appalling situation.