Do Regulators Dream of Social Values? Credibility and Responsiveness in UK Drug Funding Policies

When and how does regulation reflect demands, concerns, and values held in society? This old question has received a renewed attention in recent years, as growing politicisation of regulation has put regulators under pressure to respond to public demands. Based on a case study of drug funding policies in England, this paper examines how a regulator’s pursuit of credibility in regulation – a key quality that is considered central to the legitimacy of the regulatory state – subsequently affects the timing and the extent to which the regulator responds to pressure in the public arena. It uses process tracing to evaluate different mechanisms of regulatory policy change, where a particular focus is placed on the regulator’s behaviour before, during, and after the change. Drug funding policies provide an excellent opportunity to develop arguments about the regulatory state under pressure, since regulatory choices on whether a drug is funded by, or excluded from, the public health care system illuminates whether such choices are congruent with social values. The paper’s findings highlight how a regulator’s legitimacy bases evolve over time; they have implications for the adaptability of the regulatory state in the face of pressure.