An evaluation of partnership in the development of strategic health policy

This PhD analyses strategic health partnerships, focusing on Health Improvement Programmes (HImPs) and Health Action Zones (HAZs). It is a case study of four English health districts, based on 81 semi-structured interviews, and on partnership documents and observations. Partnership - central to New Labour's modernisation agenda for the NHS - was intended to improve the quality of health services and reduce health inequalities. This thesis conceptualises three dimensions of partnership - coordination, collaboration, participation. It uses three theoretical frameworks to interpret the nature of partnership in the study sites. Governance Theory - market, hierarchy and networks - provided a framework to conceptualise the broader context in which partnership was developed but also to explore the influence of central government on local statutory agencies. Over-use and poor co-ordination of central command and control tools strengthened hierarchical relations. Coupled with a shift towards healthcare delivery, this undermined the development of autonomous, lateral relationships. Resource Dependency Theory provided a framework to analyse the influences on horizontal relationships between local partners. This theory sees actors as selfinterested, manipulating the environment to enhance their resources while reducing their resource dependency on others. A model was developed to explain how resource motivations and symmetry combined with local circumstances to shape partnerships. Collaboration Theory provided a normative framework to assess the quality of the partnership process. According to this theory, innovative and consensual solutions to social problems emerge through inclusive processes - often involving conflict and requiring impartial facilitation. In the study sites, these processes were constrained by overbearing hierarchical relations and local influences, resulting in policy co-ordination, not radical innovation. The thesis argues that government reforms resulted mainly in partnership as coordination. Partnership as participation marginally increased while partnership as collaboration was barely evident. The shift from market to networks was undermined by the government's strengthening and (mis)management of hierarchical relations.