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 potential for neighbourhood regeneration in a period of austerity: changing forms of neighbourhood governance in two cities

Localism is an active political strategy, developed in a period of austerity by the UK's coalition government as a justification for the restructuring of state-civil society relationships. The deprived neighbourhood has long been a site for service delivery and a scale for intervention and action, giving rise to a variety of forms of neighbourhood governance. Prior international comparative research indicated convergence with the US given the rise of the self-help conjuncture and the decline of neighbourhood governance as a medium of regeneration. The subsequent shift in the UK paradigm from ‘big’ to ‘small state’ localism and deficit-reducing cuts to public expenditure confirm these trends, raising questions about the forms of neighbourhood governance currently being established, the role being played by local and central government, and the implications for neighbourhood regeneration. Two emerging forms of neighbourhood governance are examined in two urban local authorities and compared with prior forms examined in earlier research in the case study sites. The emerging forms differ significantly in their design and purpose, but as both are voluntary and receive no additional funding, better organised and more affluent communities are more likely to pursue their development. While it is still rather early to assess the capacity of these forms to promote neighbourhood regeneration, the potential in a period of austerity appears limited. Reduced funding for local services increases the imperative to self-help, while rights to local voice remain limited and the emerging forms provide little scope to influence (declining) local services and (still centralised) planning decisions, especially in neighbourhoods with regeneration needs which are likely to lack the requisite capacities, particularly stores of linking social capital. Initial conclusions suggest greater polarity and the further containment of deprived neighbourhoods.