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.

Risk and benefits in lifestyle sports: parkour, law and social value

This paper examines the interrelationship between law and lifestyle sports, viewed through the lens of parkour. We argue that the literature relating to legal approaches to lifestyle sport is currently underdeveloped and so seek to partially fill this lacuna. Hitherto, we argue, the law has been viewed as a largely negative presence, seen particularly in terms of the ways in which counter-cultural activities are policed and regulated, and where such activities are viewed as transgressive or undesirable. We argue that this is a somewhat unsophisticated take on how the law can operate, with law constructed as an outcome of constraints to behaviour (where the law authorises or prohibits), distinct from the legal contexts, environments and spaces in which these relationships occur. We argue that the distinctive settings in which lifestyle sports are practiced needs a more fine-grained analysis as they are settings which bear, and bring to life, laws and regulations that shape how space is to be experienced. We examine specifically the interrelationship between risk and benefit and how the law recognises issues of social utility or value, particularly within the context of lifestyle sport. We seek to move from user-centred constructions of law as an imposition, to a more nuanced position that looks at parkour at the intersections of law, space and lifestyle sport, in order to reveal how law can be used to support and extend claims to space.