Making Wicked Problems Governable?

Abstract

This book characterizes the nature of key reforms—namely managed networks—introduced in the UK National Health Service during the New Labour period (1997–2010). It combines rich empirical case material of eight such networks drawn from different health policy arenas with a theoretically informed analysis. It makes three main contributions. First, it argues that New Labour’s reforms included an important network element consistent with underlying network governance ideas, complementing the interpretation of other authors who have stressed either choice and markets or the continuation of NPM. It contributes to the wider NPM/post NPM debate by suggesting conditions of sedimentation. It specifies conditions of ‘success’ for these managed networks and explores how much progress was empirically evident. Second, the concept of ‘wicked problems’ is used to conceptualize many of the complex health policy arenas studied. It argues that networks are the least bad governance mode to tackle such wicked problems. Wicked problems conditions may become even more important in the future. It offers a qualified defence of network forms and caution against a whole-scale tilt to marketization in ‘wicked problem’ arenas. Third, it brings in a governmentality perspective to retheorize some of the novel organizational processes which do not fit either professional dominance or NPM models. A number of long-run policy developments under New Labour (such as clinical governance, EBM guidelines, energized clinical and managerial hybrids, patient safety regimes) appear consistent with this governmentality perspective.