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This article examines the evolution of the Private Finance Initiative in Britain since 1992 with particular reference to the health policy area. The initiative is presented as a ‘meta-policy’ in so far as it was not sectoral, but was situated above and beyond the normal run of Whitehall policies; it was also heavily ideologically driven. The evolution of the policy, however, was influenced by the policy networks and institutional interplay. In turn the PFI, as it gathered momentum, affected the culture, personnel and institutional structures within which it operated. The history of the PFI is then set against some recent theories of the policy process, particularly those produced by Peter John, stressing evolutionary approaches, and by David Marsh and Martin Smith, suggesting dialectical approaches to networks. It is suggested that there is a need for some theoretical revision which recognises the possibility that a policy itself can make a distinctive contribution to the causal process of policy change.