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

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.