The National Health Service is key to Britain's welfare state, and has been subject to repeated reform initiatives. Such reforms rarely "fix" the problems for which they are introduced, but evaluations have neglected the significance of local action. Reform implementation involves local translation of politically contextualized ideas into workable practice. I focus on implementation processes and the role of professions. Ethnographic data reveal local actors engaging with policy objectives to protect existing structures within the boundaries of official reform rhetoric. Actors employ multiple strategies to maintain existing systems. Rather than "failing," policy is made through localized collaboration.