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

Exploring the Economic Dimensions of Complexity: A Post-Positivist Evaluation of Diabetes Policy and Governance

The Evidence-Based Policy movement has become increasingly attendant to issues of complexity, with “realist” and “theories of change” methodologies now established. Yet there is scope to develop the field in this regard: economic evaluation remains firmly neoclassical despite significant criticisms of the framework. Frank Fischer has argued persuasively that issues of choice and efficiency are too normatively contested to reduce down to monetary measurement (Fischer and Forester, 1993). Furthermore, evaluations typically focus on specific polices or interventions: there is scope to develop methods to address evaluative questions of governance, concerning the arrangements through which policies are developed and delivered (Torfing et al., 2012). The present paper develops an innovative approach to evaluation by combining postpositivist “frame” analysis with heterodox political economy. The challenge of governance is conceptualised as one of facilitating coordination, a concept central to political economy. By analysing and contrasting stakeholder “frames” at different levels of governance, it is possible to establish whether and to what extent coordination is occurring. This is applied in a case study of diabetes, following the passage of the Health and Social Care Act (2012). The empirical research included thirty interviews with diabetes stakeholders between January 2012 and March 2015, spanning public health, primary care and secondary care. Stakeholders were asked for their appraisals of policy and governance, using the SWOT interview technique. Strengths and opportunities included the potential opened up for joined-up working across local authority departments and patient-centred care in general practices. Yet constrained resources, the Quality and Outcomes Framework and the purchaser-provider split were widely viewed as problematic to the successful delivery of diabetes services. The paper ends with a brief discussion of Sustainability and Transformation Plans (STPs), based on the research

Computer modeling of rocket engine ignition transients Final report

Computer modeling of rocket engine ignition transient

Ghana coastal fisheries governance dialogue: Presentations, discussions and outcomes from a stakeholder forum on issues for reforming governance of Ghana’s coastal fisheries

This meeting, the second national Fisheries Governance Dialogue, aimed to help stakeholders in the fisheries sector generate a shared understanding of critical lessons and pathways for fisheries co-management success in Ghana. This was a direct response to the call from both fisheries communities and the government of Ghana for a radical change from the way fisheries resources are currently being managed. The meeting was attended by 60 men and women from stakeholder organizations and communities, and commenced with presentations on co-management experiences from local, regional and international participants. This was followed by panel discussions to extract lessons that specifically related to successfully implementing co-management in Ghana’s fisheries. Finally, breakout groups addressed in greater detail some issues of importance to fisheries governance reform in Ghana. While fisheries co-management is not a new concept in Ghana, participants heard that previous attempts to initiate these systems proved unsustainable. A number of lessons were drawn from these past experiences

Age-dependent female responses to a male ejaculate signal alter demographic opportunities for selection

A central tenet of evolutionary explanations for ageing is that the strength of selection wanes with age. However, data on age-specific expression and benefits of sexually selected traits are lacking—particularly for traits subject to sexual conflict. We addressed this by using as a model the responses of Drosophila melanogaster females of different ages to receipt of sex peptide (SP), a seminal fluid protein transferred with sperm during mating. SP can mediate sexual conflict, benefitting males while causing fitness costs in females. Virgin and mated females of all ages showed significantly reduced receptivity in response to SP. However, only young virgin females also showed increased egg laying; hence, there was a narrow demographic window of maximal responses to SP. Males gained significant ‘per mating’ fitness benefits only when mating with young females. The pattern completely reversed in matings with older females, where SP transfer was costly. The overall benefits of SP transfer (hence opportunity for selection) therefore reversed with female age. The data reveal a new example of demographic variation in the strength of selection, with convergence and conflicts of interest between males and ageing females occurring over different facets of responses to a sexually antagonistic trait

Steering, knowledge and the challenge of governance evaluation: the case of National Health Service governance and reform in England

Drawing from ‘robust political economy’ (RPE) literature, we address evaluative questions concerning governance effectiveness in the face of complex, cross cutting problems. Central to RPE is the challenge of coordination, with its fundamental epistemological dimension requiring close attention to stakeholder knowledge about policy impacts. This focus contrasts with process-orientated analysis predominant in political science and public administration and enables holistic governance evaluation that draws from various, often demarcated, research fields. This is demonstrated through a focus on the evolution of health governance in England, particularly how diabetes services in England were affected by the 2012 Health and Social Care Act

Impacts of variable renewable energy on wholesale markets and generating assets in the United States: A review of expectations and evidence

We synthesize available literature, data, and analysis on the degree to which growth in variable renewable energy (VRE) has impacted or might in the future impact bulk power system assets, pricing, and costs in the United States. Most studies of future scenarios indicate that VRE reduces wholesale energy prices and capacity factors of thermal generators. Traditional baseload generators are more exposed to these changing market conditions than low-capital cost and more flexible intermediate and peak-load generators. From analysis of historical data we find that VRE is already influencing the bulk power market through changes in temporal and geographic patterns areas with higher levels of VRE. The most significant observed impacts have concentrated in areas with significant VRE and/or nuclear generation along with limited transmission, with negative pricing also often occurring during periods with lower system-wide load. So far, however, VRE, has had a relatively modest impact on historical average annual wholesale prices across entire market regions, at least in comparison to other drivers. The reduction of natural gas prices is the primary contributor to the decline in wholesale prices since 2008. Similarly, VRE impacts on thermal plant retirements have been limited and there is little relationship between the location of recent retirements and VRE penetration levels. Although impacts on wholesale prices have been modest so far, impacts of VRE on the electricity market will be more significant under higher VRE penetrations