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.

The Crisis in the UK's High Streets: can the evening and night-time economy help?

Changes in retailing over the last half century have had a detrimental effect on the UK’s local high streets. The recession of 2008-2012 exacerbated these trends leading to a high number of vacancies and neglected properties. The impact was sufficiently severe for the term ‘crisis’ to be used in connection with the British high street. In the academic and commercial reports generated by the recognition that the high street needed to adapt to changing circumstances, a view emerged that the leisure component of high street activity would gain in importance. This article reviews the relationship of the evening and nighttime economy to the high street and considers its potential in reinventing the vitality that is normally associated with these mixed-use urban corridors. The article argues that there is hope in the high street offering a different type of experience to the mainstream forms of entertainment that are consolidating in major town and city centres. It concludes by suggesting that for this to be successful, some public support is necessary.