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.

Professionalism and skills enhancement in the built environment: the role of higher education in a changing policy context in England

Since the election of the Labour Government in 1997 there have been a series of policy initiatives emphasising the importance of co-ordinated and integrated approaches to the delivery of urban regeneration and in particular Sustainable Communities. This changing policy context has given rise to a shortage of practitioners with both the technical skills to deliver specific programmes, and more especially the generic skills to work in multi-disciplinary teams in conjunction with partnership-based management boards. This paper discusses the origins of the debate about skills shortages and deficiencies and reviews the main government reports which have advocated a new approach to the provision of skills for community regeneration. It focuses particularly on the work of the Planning Network which was funded by the Centre for Education in the Built Environment (CEBE) to examine the contribution of higher education to the wider skills debate. It concludes by arguing that higher education has an important part to play in the provision of a more appropriate skills set for professional practice within a broader and more inclusive strategy involving all key stakeholders. However, employers also have a major responsibility in ensuring that key skills are maintained and enhanced within their own organisations.

Co-production and co-creation using self-service technology: the application of service-dominant logic

Research on how customers engage in the co-creation processes envisaged by the Servicedominant logic paradigm is currently limited and even less work has been published on frameworks for organizations to manage the co-creation process. This conceptual paper examines a particular aspect of co-creation: co-production as a result of the application of self-service technology (SST). We propose a conceptual framework for co-production, which emphasizes the need to understand productivity from the point of view of the customer, and demonstrate how this can be applied in both consumer (b2c) and interorganizational(b2b) contexts. We conclude that service organizations might benefit from clearly identifying co-production with task-performance, and co-creation with the valueattributing aspects of the customer service experience. Both aspects generate a range of design and management challenges for suppliers particularly the need to understand the cocreation process 'outputs' desired by customers and the full costs of moving away from person to person interaction.

“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.

Turning around the poorest neighbourhoods: learning the lessons from twenty years of neighbourhood-based regeneration strategies in England

In the past two decades governments in Britain have launched a series of initiatives designed to reduce the disparities between areas of affluence and deprivation. These initiatives were funded by central government and were delivered through a series of partnership boards operating at the neighbourhood level in areas with high levels of deprivation. Drawing on similar approaches in the US War on Poverty, the engagement of residents in the planning and delivery of projects was a major priority. This chapter draws on the national evaluations of three of these programmes in England: the Single Regeneration Budget, the New Deal for Communities and the Neighbourhood Management Pathfinders. The chapter begins by identifying the common characteristics of these programmes, known as area-based initiatives because they targeted areas of concentrated deprivation with a population of about 10,000 people each. It then goes on to discuss the three national programmes and summarises the main findings in relation to how far key indicators changed for the better. The final section sets out the ways in which policy objectives changed in 2010 after the election of a coalition government. This produced a shift to what was called the ‘Big Society’ where the rhetoric favoured a transfer of power away from central government towards the local, neighbourhood, level. This approach favoured self-help and a call to volunteering rather than channelling resources to the areas in greatest need. The chapter closes by reviewing the relatively modest achievements of this centralist, big-state approach to distressed neighbourhoods of 1990–2010.

Churchill as Chancellor of the Exchequer (1924–9) and the return to the gold standard

The general election of 29 October 1924 saw Winston Churchill return to Parliament as Constitutionalist MP for Epping after two years in the political wilderness. It also saw Stanley Baldwin swept back to Number 10 on a Conservative landslide. Speculation about whether Baldwin would cement Churchill’s drift from the Liberal fold by offering him office surfaced during the election campaign. Churchill nevertheless thought ‘it very unlikely that I shall be invited to join the Government, as owing to the size of the majority it will probably be composed only of impeccable Conservatives’. [ 1 ] Because of his anti-socialist credentials, his ability to reassure wavering Liberals through his opposition to protectionism – dropped by Baldwin after its rejection in the 1923 general election – and concern he could prove a rallying point for backbench malcontents, there was however much to commend giving Churchill a post. To his surprise, Baldwin offered Churchill the long-coveted office of Chancellor of the Exchequer, briefly held by his father before his ill-conceived resignation in 1887. Having arranged a meeting with his Labour predecessor, Philip Snowden, about outstanding business the new Chancellor set to work. Marking his political transition, a few days later Churchill resigned from the National Liberal Club.