1. All ministers or governments only have the time to pay attention to a small number of issues for which they are responsible. So, they may try to impose new policies in some areas but leave most untouched.
2. Ministers delegate responsibility for most policymaking to civil servants, who engage in the sort of consultation that some ministers reject.The article then shows how this process worked in UK health policy, identifying a top-down internalised process (led by Thatcher) to reform healthcare, followed by a much wider process of policy formulation in the Department of Health under Kenneth Clarke and much greater consultation under his successor William Waldegrave. It suggests that internalisation tends to fail because policymakers need information from (often a wide range of) groups, while policy imposition may only go so far before bruiser-style ministers leave their posts to be replaced by ambassadorial figures who take a more conciliatory approach to the longer process of policy implementation. This is not to say that policy does not change (it often changes radically) but that we should not exaggerate the overall effect of any government. In this regard, the Thatcherite reputation is based partly on a myth that cannot be sustained logically.