The political economy of co-ordination challenges in the National Health Service: a postpositivist evaluation of diabetes policy and governance

The present PhD thesis develops and applies an evaluative methodology suited to the evaluation of policy and governance in complex policy areas. While extensive literatures exist on the topic of policy evaluation, governance evaluation has received less attention. At the level of governance, policymakers confront choices between different policy tools and governance arrangements in their attempts to solve policy problems, including variants of hierarchy, networks and markets. There is a need for theoretically-informed empirical research to inform decision-making at this level. To that end, the PhD develops an approach to evaluation by combining postpositivist policy analysis with heterodox political economy. Postpositivist policy analysis recognises that policy problems are often contested, that choices between policy options can involve significant trade-offs and that knowledge of policy options is itself dispersed and fragmented. Similarly, heterodox economics combines a concept of incommensurable values with an appreciation of the strengths and weaknesses of different institutional arrangements to realise them. A central concept of the field is coordination, which orientates policy analysis to the interactions of stakeholders in policy processes. The challenge of governance is to select the appropriate policy tools and arrangements which facilitate coordination. Via a postpositivist exploration of stakeholder ‘frames’, it is possible to ascertain whether coordination is occurring and to identify problems if it is not. Evaluative claims of governance can be made where arrangements can be shown to frustrate the realisation of shared values and objectives. The research makes a contribution to knowledge in a number of ways a) a distinctive evaluative approach that could be applied to other areas of health and public policy b) greater appreciation of the strengths and weaknesses of different forms of evidence in public policy and in particular health policy and c) concrete policy proposals for the governance and organisation of diabetes services, with implications for the NHS more broadly.

“My people seem to be falling to bits”: impotence, memory, and the co-possibility of body and mind in Samuel Beckett’s works

The present thesis examines the representation of the impotent body and mind in a selection of Samuel Beckett’s dramatic and prose works. Aiming to show that the body-mind relation is represented as one of co-implication and co-constitution, this thesis also takes the representation of memory in Beckett’s work as a key site for examining this relation. The thesis seeks to address the centrality of the body and embodied subjectivity in the experience of memory and indeed in signification and experience more generally. In these terms, Chapter 1 analyzes the representation of the figure of the couple in Beckett’s drama of the 1950s – as a metaphor of the body-mind relation – and, in light of Jacques Derrida’s theory of the supplement and Bernard Stiegler’s theory of technics, it discusses how the relationship between physical body and mind is defined by an essential supplementarity that is revealed even (or especially) in their apparent separation. Furthermore, the impotence that marks both elements in Beckett’s writings, when it is seen to lay bare this intrication, can be viewed, in important respects, as enabling rather than merely privative. Chapter 2 discusses the somatic structure of memory as represented in four of Beckett’s later dramatic works composed in the 1970s and 1980s. Similarly to Chapter 1, the second chapter focuses on the more “extreme” representation of bodily impotence in Beckett and demonstrates that rather than a merely “mental” recollection, memory in the work of Beckett is presented as necessarily experienced through, and shaped by, the body itself. In this light, then, it is shown that despite the impotence that marks the body in Beckett’s work of the 1970s and 1980s, the body is a necessary site of memory and retains or discovers a kind of activity in this impotence. Finally, Chapter 3 shifts its attention to Beckett’s prose works in order to explore how such works, reliant on language rather than the physical performance of actors onstage, sustain questions of embodied subjectivity at their heart. Specifically, the chapter argues that, on closer inspection, Beckett’s “literature of the unword” is not an abstention from meaning and its materialization, but one that paradoxically foregrounds that “something” which remains an essential part of it, that is, an embodied subjectivity.