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.

Values in middle childhood: Social and genetic contributions

Theories of value development often identify adolescence as the period for value formation, and cultural and familial factors as the sources for value priorities. However, recent research suggests that value priorities can be observed as early as in middle childhood, and several studies, including one on preadolescents (Knafo & Spinath, 2011), have suggested a genetic contribution to individual differences in values. In the current study, 174 pairs of monozygotic and dizygotic 7-year old Israeli twins completed the Picture-Based Value Survey for Children (PBVS–C; Döring et al., 2010). We replicated basic patterns of relations between value priorities and variables of socialisation – gender, religiosity, and socioeconomic status– that have been found in studies with adults. Most important, values of Self-transcendence, Self-enhancement, and Conservation, were found to be significantly affected by genetic factors (29%, 47% and 31% respectively), as well as non-shared environment (71%, 53% and 69% respectively). Openness to change values, in contrast, were found to be unaffected by genetic factors at this age and were influenced by shared (19%) and non-shared (81%) environment. These findings support the recent view that values are formed at earlier ages than had been assumed previously, and they further our understanding of the genetic and environmental factors involved in value formation at young ages.