‘How great expectations in Westminster may be dashed locally’: the local implementation of national policy on health inequalities

English Tackling health inequalities is a policy priority for the Labour government in the UK. We use Kingdon’s model of ‘policy streams’ to explain how the issue of health inequalities gets onto the policy agenda nationally and locally, and how it is being implemented. Using empirical evidence from local agencies, we suggest that the issue of health inequalities is on the agenda nationally and locally but implementation is hampered by deficiencies in performance management, insufficient integration between policy sectors, and contradictions between health inequalities and other policy imperatives. Thus, the government’s expectations are not only dashed locally, but also local expectations are being dashed at the centre.