Repoliticising national policy mobilities: Resisting the Americanization of universal healthcare

Policy mobilities scholarship has comprehensively challenged the methodological nationalism and rational orthodoxies of policy studies. Contributing to recent debates on policy mobilities and post-politics, this paper examines how struggles over the ‘national’ shape policy on the move. Focussing on attempts to embed accountable care models across the English National Health Service (NHS), I consider how ‘integration’ has been mobilised as a seemingly irresistible solution to the failures of market-orientated healthcare reforms in times of austerity. Yet, I foreground how campaigners slowed down the local contracting of accountable care through repoliticising circulating policy as the ‘Americanization’ of the NHS. The paper emphasises the ongoing, yet shifting and politically contested, role of the state and national spatial imaginaries in the making and translating of globally mobile policy. Rethinking the times and spaces of politics and policy in the current conjuncture, I conclude by warning of the limits of nostalgia for the post-war national welfare state when pushing for universal healthcare as a right for all

The limits to openness: Co-working, design and social innovation in the neoliberal city

This article examines the emergence of ‘open’ urban economic projects that promote the transformative potential of social innovation and civic enterprise. By putting the burgeoning literature on an open paradigm of work and innovation within cultural economic geography into dialogue with scholarship on open cities, I problematize the inherently progressive framing of openness. The paper makes two contributions. First, it emphasises how open narratives encourage entrepreneurial communities that manifest as individualization-masked-as-collectivism. It argues efforts to design new spaces of social innovation through the blurring of boundaries simultaneously reproduce social and material exclusions. Second, it demonstrates how the championing of open ecosystems of social innovation intersects with austerity localism. New modes of state withdrawal are facilitated through co-creation, crowdfunding and social enterprise. Illustrated through research into a co-working space in London set up in response to the 2007–2008 economic crisis, I reveal the geographies of exclusion, enclosure and exploitation embedded in the pursuit of openness. Against the claims of enabling conditions for progressive civic futures, I establish the limits to openness whereby such ideas are easily assimilated into the processes of neoliberalisation that they seek to reject

The multiple trajectories of coworking: reimagining space, work and architecture

Research into coworking has failed to take space seriously. I address this concern by analysing three ‘coworking spaces’ as meeting places constituted as a ‘bundle of trajectories’, following Doreen Massey’s (2005) reimagining of space. Understood as the product of lively interrelations and coexisting heterogeneity, I examine claims that these pay-to-access shared workplaces create the conditions for happenstance meetings between ‘like-minded entrepreneurs’. In doing so, I make connections with feminist and poststructural geographies concerned with relational performances, working bodies and diverse economic practices (Gregson and Rose, 2000; McDowell, 2009 and Gibson-Graham, 2006a; 2006b). By researching through coworking, I make three interconnected arguments. Firstly, despite attempts to separate spaces of home and work, these boundaries are continuously negotiated and contested. Secondly, amidst claims that these architectural spaces are designed to feel like ‘fast-paced laboratories’ orchestrating chance encounters, I insist that embodied experiences can be far more ambiguous. Thirdly, I consider how the performative ontologies of diverse economies might fracture and infect the coherence of these apparently ‘entrepreneurial’ spaces. Together, this brings a new perspective to recent geographic scholarship on architectural inhabitations addressing concerns that there has been limited attention towards human subjectivities

Moving policy out of time - commentary to Refstie

This paper is prompted by Hilde Refstie’s lecture on co-production and the role of academia in the search for sustainability in times of fast policymaking. My aim is to keep the conversation going by reflecting on how policy researchers negotiate all kinds of tensions and contradictions when traversing academic and policy worlds. It seems to me that those involved in making and researching fast policy are – in rather different ways – moving out of time: there is an urgent search for ‘solutions’ to the many, different crises we are now facing. Yet, the very existence of political alternatives requires holding open the possibility of interrupting the now all-too-familiar rhythms of fast policy. While calls for ‘slow scholarship’ may push back against the increasing tempo of the neoliberal academy, if we are not careful such appeals risk reproducing existing exclusions and inequalities, not least among those struggling by on temporary contracts. Confronting these dilemmas and antagonisms may help go some way towards reconfiguring research relevance in the present political moment

Designing for Imprisonment: Architectural Ethics and Prison Design

Architectural ethics has only begun to consider in earnest what it means, in a moral sense, to be an architect.1 The academy, however, has yet to adequately to explore the ethical problems raised,2 to evaluate the types of moral issues that arise, and to develop moral principles or moral reasons that should guide decisions when encountering these moral issues inherent in certain project types. This is the case despite the practice of architecture entailing “behaviours, our choices of which may be illuminated by ethical analysis.”3 Although distinguishing practice from product allows ethical critique of the practice involved in designing buildings, and recognises the significance of the architect’s moral agency, there remains very little empirically-based understanding of how the architect, once identified as a moral agent, operates as such, and still less about the circumstances in which ‘professional’ conduct may be at odds with ‘ethical’ behaviour

Regional assemblage and the spatial reorganisation of health and care: the case of devolution in Greater Manchester, England

In this paper, we examine how space is integral to the practices and politics of restructuring health and care systems and services and specifically how ideas of assemblage can help understand the remaking of a region. We illustrate our arguments by focusing on health and social care devolution in Greater Manchester, England. Emphasising the open?ended political construction of the region, we consider the work of assembling different actors, organisations, policies and resources into a new territorial formation that provisionally holds together without becoming a fixed totality. We highlight how the governing of health and care is shaped through the interplay of local, regional and national actors and organisations coexisting, jostling and forging uneasy alliances. Our goal is to show that national agendas continued to be firmly embedded within the regional project, not least the politics of austerity. Yet through keeping the region together as if it was an integrated whole and by drawing upon new global policy networks, regional actors strategically reworked national agendas in attempts to leverage and compete for new resources and powers. We set out a research agenda that foregrounds how the political reorganisation of health and care is negotiated and contested across multiple spatial dimensions simultaneously

Urban Landscapes and the Atmosphere of Place: Exploring Subjective Experience in the Study of Urban Form

Urban landscapes are produced through the combination of material forms and subjective human experience. Drawing on the concept of atmosphere, we argue that human experience of urban spaces drives alterations to the built environment, making it critical that these are studied in tandem. Atmosphere is created through the combination of human activity, individual emotional responses and subjective perceptions of built forms. Though unique to the individual, it can also create a shared feeling of place. Drawing on ethnographic methods to examine people's experience of the Balsall Heath district in Birmingham, UK, a series of examples is used to illustrate how the interrelationship of subjective experience and built forms creates different atmospheres within the neighbourhood. These, and the desire to alter them, are in turn driving morphological change

Thinking conjuncturally, looking elsewhere

Inspired by Jamie Peck’s (2023) article on conjunctural methodologies, we discuss how geographers might interpret these troubling times. We hope to keep the conversation going by suggesting that a strength of conjunctural analysis lies in trying to get to grips with multiple crises without always knowing precisely where to look. Another strength of this approach is to take seriously all the cultural and political work involved in the articulation of different struggles, tensions, and contradictions combining in complex, and sometimes surprising, ways. So, in addition to looking inwards to economic geography, we suggest that thinking conjuncturally might also involve looking elsewhere to ask what’s at stake in the present moment – in all its complexity – in order to bring other political possibilities into view

Integrated Care Systems: What can current reforms learn from past research on regional co-ordination of health and care in England? A literature review ? Executive summary

This report is part of the research of the Policy Research Unit in Health and Social Care Systems and Commissioning (PRUComm) on the developing architecture of system management in the English NHS – including Sustainability and Transformation Partnerships, Integrated Care Systems or their successors – commissioned by the Department of Health and Social Care. Five years since the publication of the Five Year Forward View (NHS, 2014), the integration of health and social care at a ‘system’ level remains a central NHS policy priority in England. The NHS Long Term Plan (NHS, 2019a) further set out how organisations are to continue to work together collaboratively across bounded geographic territories with the aim of improving co-ordination of local health and care services to encourage the better use of resources and through managing population health. Without change to legislation, encouraging system-wide collaboration marks a major shift in policy direction away from the primacy of quasi-market competition. Forty-four non-statutory Sustainability and Transformation Partnerships (STPs) of NHS commissioners and providers, local authorities, and in some cases, voluntary and private sector organisations have been formed across England. Fourteen of the more ‘mature’ partnerships have since been designated Integrated Care Systems (ICSs) to be granted increased autonomy, providing greater freedom over how they manage resources collectively. There are usually three spatial levels of organisation within each STP/ICS: ‘neighbourhoods’ covering a population of roughly 30,000 – 50,000; ‘place’ between 250,000-500,000 people and STP/ICS ‘system’ level between 1 million – 3 million. In addition, seven new regional teams bring together NHS England and NHS Improvement at a regional level, intended to harmonise their operations for system-wide working. Despite undergoing continuous reinvention, an intermediate tier has existed for most of the history of the English NHS, with statutory authorities (at times, several layers of authorities) responsible variously for long-term strategic planning, allocating resources, acting as market umpires, and overseeing delivery of local health services. The latest reforms mark a return of an intermediate tier, filling a vacuum left behind by the abolition of Strategic Health Authorities (SHAs) in 2013. However, unlike previous health authorities, STPs and ICSs are not statutory bodies, but instead exist as non-statutory voluntary partnerships despite being effectively mandated by NHS England. This report presents the findings of a review of literature on previous intermediate tiers in the NHS. Drawing on peer-reviewed academic research, historical analysis and commentary from academic and policy sources, it examines their functions and responsibilities, how they operated in practice and their interaction with local government. Putting current reforms in their geographical and historical context, we draw out lessons for the challenges and opportunities STPs and ICSs may encounter in the years ahead