Health care needs and health policy : the case of renal services.

PhDThis thesis presents a critical ethnography of decision making with respect to the assessment of health care needs in the UK health system. Theories of need, justice and rights are reviewed in relation to structural changes to the National Health Service, together with the different theoretical approaches underpinning health policy based on human needs. The research on which this thesis is based focuses on a case study of an independent review of renal services in London, concentrating on the needs assessment work of the review group set up by the government and the decision making debates this review group engaged in. The methods used are based on a participatory, critical ethnography. The review process is evaluated critically by relating the technical knowledge produced by the group to a theoretical framework for assessing needs and by using a Habermasian perspective to investigate the ways in which the language of need is used to legitimise the agendas of various vested interests. This work is linked with an analysis of quasi-markets in the health service to explore the capacity that the technical discourses of markets and contracting have for reinforcing the ideological distortions identified in the analysis of the group's debates concerning need. Finally, by linking an analysis based on a case study of renal services to theoretical understandings of health care needs and health policy, a general critique of the UK health system is constructed

Elite city-deals for economic growth? Problematizing the complexities of devolution, city-region building, and the (re)positioning of civil society

The concept of localism and spatial delineation of the ‘city region’ have seen a renaissance as the de facto spatial political units of governance for economic development. One articulation of this has seen the creation of Cardiff Capital Region (CCR) to potentially enhance Wales’s poor economic performance and secure democratic forms of social cohesion. City regions have been vaunted as the ‘spatial imaginary’ for engendering economic development, but there are considerable state spatial restructuring tensions. The paper discusses these by following the development of city-regionalism in Wales and specifically the unfolding of the ‘elite-led’ CCR City-Deal

Social class, dementia and the fourth age

Research addressing social class and dementia has largely focused on measures of socioeconomic status as causal risk factors for dementia and in observed differences in diagnosis, treatment and care. This large body of work has produced important insights but also contains numerous problems and weaknesses. Research needs to take account of the ways in which ageing and social class have been transformed in tandem with the economic, social and cultural coordinates of late modernity. These changes have particular consequences for individual identities and social relations. With this in mind this article adopts a critical gaze on research that considers interactions between dementia and social class in three key areas: (i) epidemiological approaches to inequalities in risk (ii) the role of social class in diagnosis and treatment and (iii) class in the framing of care and access to care. Following this, the article considers studies of dementia and social class that focus on lay understandings and biographical accounts. Sociological insights in this field come from the view that dementia and social class are embedded in social relations. Thus, forms of distinction based on class relations may still play an important role in the lived experience of dementia

Connected Growth: developing a framework to drive inclusive growth across a city-region

This ‘in perspective’ piece addresses the (re-)positioning of civil society within new structures of city-region governance within Greater Manchester (GM). This follows on from the processes of devolution, which have given the Greater Manchester City-Region (GMCR) a number of new powers. UK devolution, to date, has been largely focused upon engendering agglomerated economic growth at the city-region scale. Within GMCR, devolution for economic development has sat alongside the devolution of health and social care (unlike any other city-region in the UK) as well. Based on stakeholder mapping and semi-structured interviews with key actors operating across the GMCR, the paper illustrates how this has created a number of significant tensions and opportunities for civil society actors, as they have sought to contest a shifting governance framework. The paper, therefore, calls for future research to carefully consider how civil society groups are grappling with devolution; both contesting and responding to devolution. This is timely given the shifting policy and political discourse towards the need to deliver more socially-inclusive city-regions

The moral economy of failure

This paper attempts to place contemporary market and state-based surveillance and monitoring regimes within a moral economy framework with the aim of developing a sociological approach to the moral economy of failure. The paper begins by reviewing different understandings of moral economy and their applications, both historical and contemporary, across different political, economic, and cultural contexts. It then sets out an approach to moral economy that focuses both on the norms and sentiments that frame economic and social relations and their associated practices as well as the ways in which these practices are legitimated. Following this the paper examines the literature on failure in different spaces including failure of markets, valuation regimes, and innovations. We focus on organisational and professional failures, market failures, failures of governance and policy and failures in innovation and experimentalism. In each case the discussion relates the scholarship on failure to the moral economy highlighting the interrelationships between the two and how practices related to failure are reframed and legitimated. Our discussion highlights a double standard with respect to failure. For some, generally the wealthy and powerful, it is possible to embrace failure; to hold it up as an example of ones capacity to adapt, to survive to embrace new ideas and through individual resilience, to learn and grow from the experience. But in other circumstances particularly for those living in poverty, for marginal groups and for the racially profiled, failure attracts shame, stigma, and punishment. We conclude by arguing that a research agenda addressing the moral economy of failure needs to be built on socio-historical understandings of failure in different contexts, cultures, and environments. We suggest this offers a way of identifying progressive futures and acts as an antidote to much of the hype that underpins contemporary accounts of success and innovation

What’s so critical about it? An analysis of critique within different strands of critical gerontology

Shortly after emerging in the 1980s, critical gerontology became a recognised part of mainstream gerontology. Under the umbrella of ‘critical gerontology’ sits a number of orientations that draw attention to how ageing is socially located, while foregrounding the importance of values in ageing research. Nevertheless, as critical gerontology is not a clearly defined field or orientation, inconsistencies in the use of ‘critique’ among critical gerontologists has been fermenting internal tensions. In this paper we draw on recent debates on critique as a form of discourse that aims to criticise a deficient social order with the aim of helping to bring about a good society, to identify four discourses of critique. These include the discourses of immanent critique and of transcendent critique, critique that focuses on tensions between these two, and critique that builds on constructive combinations of immanence and transcendence. We add to these an extra level of depth by distinguishing how critical discourse is applied in each case. We use this framework to identify the discourses of critique deployed in variants of critical gerontology. Here, we distinguish political economic, lifecourse, humanistic and culturalist approaches within critical gerontology and assess how each of these applies a discourse of critique. We find that these gerontological perspectives draw on a variety of discourses of critique and make use of varying degrees of engagement with critical discourse. The paper concludes by discussing how critical gerontology may develop as a reflective forum commenting on and integrating insights offered by its own varieties of critique and connecting these with macro-social analyses

Introduction: Failed! The sociological analysis of failure

In recent years the social sciences have been paying closer attention to failure, to its manifestations in the contemporary world and to the modalities of dealing with it both in theory and in practice. An emergent and interdisciplinary field of analysis has been consolidating under the label of failure studies reflecting a number of social trends. These include the instability of winner-take-all systems, the ubiquity of the new spirit of capitalism, metric-based forms of governmentality, platformization, and changes in cultural attitudes to failure. We argue that the normality of failure calls for a better conceptualization of it. What is needed is a clearer thinking about what failure really means, a better understanding of the mechanisms that generate, reproduce, and terminate it as a normal part of life. The essays collected for this symposium offer fresh insights on the analysis of failure. Taking different areas of social life as a focus, they critically examine the failures of large complex socio-technical systems; the purposefully agency of players in systems failure; the failures of governance and metagovernance; new meanings of policy failures; kaleidoscopic failure; network failure and the moral economy of failure. In doing so they we suggest that a sociology of failure needs to be built on socio-historical understandings of failure in different contexts, cultures, and environments

Elite city-deals for economic growth? Problematizing the complexities of devolution, city-region building, and the (re)positioning of civil society

The concept of localism and spatial delineation of the ‘city region’ have seen a renaissance as the de facto spatial political units of governance for economic development. One articulation of this has seen the creation of Cardiff Capital Region (CCR) to potentially enhance Wales’s poor economic performance and secure democratic forms of social cohesion. City regions have been vaunted as the ‘spatial imaginary’ for engendering economic development, but there are considerable state spatial restructuring tensions. The paper discusses these by following the development of city-regionalism in Wales and specifically the unfolding of the ‘elite-led’ CCR City-Deal

Placing the Foundational Economy: An emerging discourse for post-neoliberal economic development

Emerging in the mid-2010s, the Foundational Economy has been heralded as ‘a compelling counter-project against neoliberalism’ and ‘an alternative pathway … [for] progressive political renewal’. Grounded in a review of cross-disciplinary debates, this paper introduces the concept of the Foundational Economy and places it in relation to heterodox geographic theories of socio-economic development such as the ‘social economy’ and ‘diverse economies’ literature. Whilst there are clear overlaps, the concept of the Foundational Economy can be distinguished through its commitment to (a) a zonal perspective; (b) a focus on maximalist social innovations; and (c) the reconstitution of citizenship. In radical combination, it is argued that the lens of the Foundational Economy facilitates ‘a trenchant critique and denaturalization of current conditions, in tandem with creative explorations of the political economy of alternatives’. The paper concludes by reflecting on current oversights and future research trajectories for Foundational Economy research

Beyond the unitary state: multi-level governance, politics, and cross-cultural perspectives on animal welfare

Simple Summary: Existing cross-cultural research on animal welfare often overlooks the way that policy and law are not the exclusive domain of central government. This can result in an over-simplification or misrepresentation of the true situation. The political culture and institutional arrangements for governing the modern state are more complex than a “one-size-fits-all” approach. It is argued that cross-cultural research needs to give greater attention to differences within as well as between unitary states. Specifically, it needs to examine developments in constituent nations and territories. Here we illustrate this by drawing on new research in the United Kingdom, and examine how ‘devolution’—or decentralized government for Wales and Scotland—is providing contrasting opportunities for NGOs, campaigners, and the public to lobby to improve animal welfare policy based on local practices, beliefs, and demands (collectively known as the “political culture”). Our findings show how this is important because it results in contrasting animal welfare policies and laws in the constituent nations of the UK. Abstract: It is argued that extant cross-cultural research on animal welfare often overlooks or gives insufficient attention to new governance theory, civil society, politics, and the realities of devolved or (quasi-)federal, multi-level governance in the modern state. This paper synthesizes relevant social theory and draws on new empirical findings of civil society accounts of campaigning on animal welfare policies and law in the United Kingdom. It is presented as a corrective to arguably reductive, earlier unitary state-based analyses. Our core, evidence-based argument is that cognizance of civil society activism and the contrasting institutional governance structures and political cultures of constituent nations in unitary states—such as the UK—are providing opportunities for the territorialization of legally grounded animal welfare regimes, and culturally distinctive practices