Logics of marginalisation in health and social care reform: integration, choice, and provider-blind provision

Jason Glynos, Ewen Speed, Karen West*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

The period 2010–2013 was a time of far-reaching structural reforms of the National Health Service in England. Of particular interest in this paper is the way in which radical critiques of the reform process were marginalised by pragmatic concerns about how to maintain the market-competition thrust of the reforms while avoiding potential fragmentation. We draw on the Essex school of political discourse theory and develop a ‘nodal’ analytical framework to argue that widespread and repeated appeals to a narrative of choice-based integrated care served to take the fragmentation ‘sting’ out of radical critiques of the pro-competition reform process. This served to marginalise alternative visions of health and social care, and to pre-empt the contestation of a key norm in the provision of health care that is closely associated with the notions of ‘any willing provider’ and ‘any qualified provider’: provider-blind provision.

Original languageEnglish
Pages (from-to)45-68
Number of pages24
JournalCritical Social Policy
Volume35
Issue number1
Early online date1 Sep 2014
DOIs
Publication statusPublished - Feb 2015

Keywords

  • discourse theory
  • health care integration
  • logics
  • marginalisation
  • nodal analysis

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