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.

Queering Apartheid: The National Party’s 1987 ‘Gay Rights’ Election Campaign in Hillbrow

This article investigates the anomaly in apartheid history of the ruling National Party's (NP) fielding a ‘pro-gay rights’ candidate in the Hillbrow constituency during the 1987 whites-only election in South Africa. The NP was aided in its Hillbrow campaign by the gay magazine Exit, which encouraged its readership to ‘vote gay’ in the election and published a list of candidates who were favourable to gay rights in South Africa. The Hillbrow campaign is intelligible when the intersections between race and sexuality are analysed and the discourses wielded by the NP and Exit are spatially and historically situated. The Hillbrow/Exit gay rights campaign articulated discourses about the reform of apartheid in white self-interest and conflated white minority and gay minority rights, thereby contributing to the NP's justification for apartheid. The NP candidate's defeat of the incumbent Progressive Federal Party (PFP) MP for Hillbrow, Alf Widman, was trumpeted by Exit as a powerful victory and advance for gay rights in South Africa, but the result provoked a sharp backlash among many white gay men and lesbian women who organised to openly identify with the liberation movement. The Exit/Hillbrow campaign problematises the singular assumptions that are often made about race and sexuality in apartheid South Africa, and illustrates how political, social and economic crisis can provoke reconfigurations of identities vis-à-vis the status quo.

'I am not an Honourable Lady': gender and language in the National Assembly for Wales

Women have been historically underrepresented in political institutions and it has been claimed that it is difficult for women to succeed in the masculinist cultures that exist in political contexts. The ‘new’ devolved institutions of the UK offer opportunities to investigate gender inequality in political contexts which have a greater proportion of women members; that have included women from their inception; and that have been designed with egalitarian issues to the fore. Here, ethnographic and discourse analytic data is used to assess a senior woman’s performance in the National Assembly for Wales; to explore politicians’ appraisal of this performance; and to analyse the breakdown of the debate floor in terms of ‘rule-breaking’ activities such as barracking. In this Community of Practice the individual’s performance draws upon communicative styles that are both stereotypically masculine (adversarial) and feminine (consensual), which can be viewed as an indication of the speaker’s competence. However, this is undermined by the speaker’s failure to adopt the correct linguistic practices for this CoP which leads to the breakdown of the formal debate discourse. Assembly Members appraise this failure negatively while also drawing upon stereotypical notions of gendered communicative norms and wider discourses of gender differentiation.