Lack of support in the politics stream
According to interviewees, the reasons for the implemen- tation gap were the lack of authority within the group, and a lack support for the recommendations outside the group. Firstly, there was a perceived lack of “authority and the mandate to go off and make things happen” in the group. The group “was given a brief but it wasn’t given all the powers. It was purely advisory and it wasn’t very clear how the advisory function would be translated to imple- mentation”. There was no specific budget to make chan- ges or allocate resources, and there was an absence of representation within the group to drive change from in- side the system.
Earlier changes to the structure of the health system meant the Department of Health was responsible for policy making while the HSE was charged with service delivery. Hence, the EAG was left in an “invidious pos- ition” without “the power to make policy or the power to
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implement it”. Secondly, interviewees described the “non- movement, non-commitment and non-support” for imple- mentation from the central executive. According to one participant, two conditions necessary for implementation were that “the executive want it to be done and feel re- quired to implement what is proposed”. The failure to link the formulation stage with implementation created a situ- ation whereby “the recommendations aren’t owned by those that might be able to implement them”. The lack of impetus from within the HSE, a deficiency in the political stream, corresponds to Kingdon’s observation that some- times a cause lacks sufficiently powerful supporters lead- ing to inertia.