This chapter looks empirically at the field of health technology assessment (HTA) and argues that it is possible to identify the ‘defence’ style of hyper-active governance posited in the previous chapter. HTA is the crucial expert policy area, involving deciding which drugs and other medical treatments are safe and cost-effective to be prescribed by a local doctor or hospital. HTA has been described by international organisations promoting its use as ‘the systematic evaluation of the properties and effects of a health technology, addressing the direct and intended effects of this technology, as well as its indirect and unintended consequences, and aimed mainly at informing decision making regarding health technologies’ (www.inahta.org). It is a process for making delicate decisions about whether a country will fund a medicine, often based on variants of cost–benefit analysis. In this sense, HTA is a classic arena of expert governance: it is the attempt to turn highly emotive decisions about life and death – about who gets access to new potentially life saving drugs and medical treatments – into rational, evidence-based questions of medical science.

Hyper-active governance is about more than just government resisting public demands that they intervene in expert-led agencies. Often intervention is required to protect the status quo. Emergencies are a good example of this. In the event of a terrorist attack, a bush fire or a fire in a nightclub, politicians are expected to be in control of the situation. However, this does not mean that they rely any less on experts and expertise. In fact, during emergencies experts are arguably even more important. Ministers need information on the ground, expert assessments of whether things are going to get better or worse, how the situation is expected to progress and what might be done to alleviate human suffering in a highly contingent and dynamic context. They hence create emergency technocratic agencies staffed with scientists and experts in all aspects of emergency prevention, response and recovery.