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 role of paradigm analysis in the development of policies for a resource efficient economy

Policy makers are often called upon to navigate between scientists’ urgent calls for long-term concerted action to reduce the environmental impacts due to resource use, and the public’s concerns over policies that threaten lifestyles or jobs. Against these political challenges, resource efficiency policy making is often a changeable and even chaotic process, which has fallen short of the political ambitions set by democratically elected governments. This article examines the importance of paradigms in understanding how the public collectively responds to new policy proposals, such as those developed within the project DYNAmic policy MiXes for absolute decoupling of environmental impact of EU resource use from economic growth (DYNAMIX). The resulting proposed approach provides a framework to understand how different concerns and worldviews converge within public discourse, potentially resulting in paradigm change. Thus an alternative perspective on how resource efficiency policy can be development is proposed, which envisages early policies to lay the ground for future far-reaching policies, by altering the underlying paradigm context in which the public receive and respond to policy. The article concludes by arguing that paradigm change is more likely if the policy is conceived, framed, designed, analyzed, presented, and evaluated from the worldview or paradigm pathway that it seeks to create (i.e. the destination paradigm).