The Multiple Streams Theory of the policy process was developed in the United States in 1990s, yet it re- mains a popular choice for understanding the health policy process in Europe [42-44]. Previous studies identi- fied the lack of problem definition and the absence of con- crete proposals as barriers to the policy window [44,45]. However, in this study, there was consensus on what should be done and how to do it but the political cli- mate was unfavourable. Our analysis indicated overall agreement on diabetes as a health system priority and consensus on the best approach to its management influ- enced by national and international experience. Kingdon’s concept of a ‘softening up’ process, whereby ideas are reiterated and repackaged over time, fits with the EAG process, which took place against a backdrop of numerous proposals and reports on how to improve services. This influence is often referred to as path dependency, whereby decision-making is constrained by previous proposals and historical context [46].
International approaches to diabetes care were consid- ered in light of the Irish context and local circumstances. This is similar to the findings of Tervonen et al. [42], who examined the transfer of the WHO Health for All policy. They found that as Portugal and Finland lagged behind in terms of public health policy in Europe, the policy stream was more open to policy transfer but only for elements of the policy that fit with the policy context of that country. Although Ireland could be viewed as lagging behind internationally in terms of the organisa- tion and integration of diabetes care, the EAG were keen to contextualise proposals to make implementation more feasible.
The findings of this study highlight the dynamic un- stable nature of the policy process and the fleeting op- portunity for change. The convergence of streams is not considered a passive or automatic process within the Mul- tiple Streams Theory [21]; policy entrepreneurs look for