IDEAS home Printed from https://ideas.repec.org/p/ehl/lserod/120265.html
   My bibliography  Save this paper

Austerity and the shaping of the ‘waste watching’ health professional: A governmentality perspective on integrated care policy

Author

Listed:
  • Kendrick, Hannah
  • Mackenzie, Ewan

Abstract

Discussion related to the boundary between health and social care has existed in the United Kingdom (UK) since the inception of the English National Health Service (NHS), with successive governments outlining a desire to ‘integrate’ care. Globally, high-income, and low- and middle-income countries, are increasingly advocating integrated care (IC) as a solution to financial and quality issues. Recent research has argued that IC policy works discursively to manage tensions between competing policy aims, facilitating the continuation of austerity measures and the fragmentation of health and social care services. This paper extends this debate by moving beyond the discursive realisation of IC policy in official governmental texts to instead investigate its reception among practitioners ‘on the ground’. By complementing the perspective of governmentality with Fairclough's (2008) Dialectical Relational Approach (DRA), our paper exposes shifting articulations and enactments of IC policy discourse as it moves through implementation in a community based integrated care service (CBIC) in England. Faced with the material reality of funding cuts to the service, integrated care is reformulated from ‘transformational change’ to the responsibilisation of ‘ideal integrated workers’ tasked with eliminating ‘waste’. Whilst frontline staff strongly resisted these subjectivities, they were ultimately subject to the harmful material effects of austerity politics with little in the way of positive change for patient care.

Suggested Citation

  • Kendrick, Hannah & Mackenzie, Ewan, 2023. "Austerity and the shaping of the ‘waste watching’ health professional: A governmentality perspective on integrated care policy," LSE Research Online Documents on Economics 120265, London School of Economics and Political Science, LSE Library.
  • Handle: RePEc:ehl:lserod:120265
    as

    Download full text from publisher

    File URL: http://eprints.lse.ac.uk/120265/
    File Function: Open access version.
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Waring, Justin & Latif, Asam & Boyd, Matthew & Barber, Nick & Elliott, Rachel, 2016. "Pastoral power in the community pharmacy: A Foucauldian analysis of services to promote patient adherence to new medicine use," Social Science & Medicine, Elsevier, vol. 148(C), pages 123-130.
    2. Hammond, Jonathan & Lorne, Colin & Coleman, Anna & Allen, Pauline & Mays, Nicholas & Dam, Rinita & Mason, Thomas & Checkland, Kath, 2017. "The spatial politics of place and health policy: Exploring Sustainability and Transformation Plans in the English NHS," Social Science & Medicine, Elsevier, vol. 190(C), pages 217-226.
    3. Humphries, Richard, 2015. "Integrated health and social care in England – Progress and prospects," Health Policy, Elsevier, vol. 119(7), pages 856-859.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Moss, Charlie & Anselmi, Laura & Morciano, Marcello & Munford, Luke & Stokes, Jonathan & Sutton, Matt, 2023. "Analysing changes to the flow of public funding within local health and care systems: An adaptation of the System of Health Accounts framework to a local health system in England," Health Policy, Elsevier, vol. 137(C).
    2. Exworthy, Mark & Powell, Martin & Glasby, Jon, 2017. "The governance of integrated health and social care in England since 2010: great expectations not met once again?," Health Policy, Elsevier, vol. 121(11), pages 1124-1130.
    3. Daniel Rippon & Andrew McDonnell & Michael Smith & Michael McCreadie & Mark Wetherell, 2020. "A grounded theory study on work related stress in professionals who provide health & social care for people who exhibit behaviours that challenge," PLOS ONE, Public Library of Science, vol. 15(2), pages 1-23, February.
    4. Petrakaki, Dimitra & Hilberg, Eva & Waring, Justin, 2018. "Between empowerment and self-discipline: Governing patients' conduct through technological self-care," Social Science & Medicine, Elsevier, vol. 213(C), pages 146-153.
    5. Shih, P. & Worth, H. & Travaglia, J. & Kelly-Hanku, A., 2017. "Pastoral power in HIV prevention: Converging rationalities of care in Christian and medical practices in Papua New Guinea," Social Science & Medicine, Elsevier, vol. 193(C), pages 51-58.
    6. Duminy, Lize & Ress, Vanessa & Wild, Eva-Maria, 2022. "Complex community health and social care interventions – Which features lead to reductions in hospitalizations for ambulatory care sensitive conditions? A systematic literature review," Health Policy, Elsevier, vol. 126(12), pages 1206-1225.
    7. Li, Yan, 2022. "Social care for disabled elderly women in urban China: The roles of the community," Social Science & Medicine, Elsevier, vol. 314(C).
    8. Butler, Clare, 2019. "Working the 'wise’ in speech and language therapy: Evidence-based practice, biopolitics and ‘pastoral labour’," Social Science & Medicine, Elsevier, vol. 230(C), pages 1-8.
    9. Qian Sun & Mary Loveday & Saw Nwe & Nike Morris & Emily Boxall, 2023. "Green Social Prescribing in Practice: A Case Study of Walsall, UK," IJERPH, MDPI, vol. 20(17), pages 1-20, September.
    10. Sanderson, Marie & Allen, Pauline & Moran, Valerie & McDermott, Imelda & Osipovic, Dorota, 2020. "Agreeing the allocation of scarce resources in the English NHS: Ostrom, common pool resources and the role of the state," Social Science & Medicine, Elsevier, vol. 250(C).
    11. Lalani, Mirza & Bussu, Sonia & Marshall, Martin, 2020. "Understanding integrated care at the frontline using organisational learning theory: A participatory evaluation of multi-professional teams in East London," Social Science & Medicine, Elsevier, vol. 262(C).

    More about this item

    Keywords

    integrated care policy; governmentality; critical discourse analysis; lean; austerity; health and social care; healthcare workers;
    All these keywords.

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:ehl:lserod:120265. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: LSERO Manager (email available below). General contact details of provider: https://edirc.repec.org/data/lsepsuk.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.