Abstract

In this paper, we examine how space is integral to the practices and politics of restructuring health and care systems and services and specifically how ideas of assemblage can help understand the remaking of a region. We illustrate our arguments by focusing on health and social care devolution in Greater Manchester, England. Emphasising the open‐ended political construction of the region, we consider the work of assembling different actors, organisations, policies and resources into a new territorial formation that provisionally holds together without becoming a fixed totality. We highlight how the governing of health and care is shaped through the interplay of local, regional and national actors and organisations coexisting, jostling and forging uneasy alliances. Our goal is to show that national agendas continued to be firmly embedded within the regional project, not least the politics of austerity. Yet through keeping the region together as if it was an integrated whole and by drawing upon new global policy networks, regional actors strategically reworked national agendas in attempts to leverage and compete for new resources and powers. We set out a research agenda that foregrounds how the political reorganisation of health and care is negotiated and contested across multiple spatial dimensions simultaneously.

Highlights

  • The political reorganisation of health and care is both temporal and spatial

  • Where scholarship has engaged with the political construction of space shaping healthcare reform, there is a tendency for analysis to privilege a single spatial dimension as the definitive concept for examining historical or contemporary changes (Jessop et al 2008)

  • We have sought to illustrate how and why space is integral to the practices and politics of restructuring health and care and how ideas of assemblage can help understand the remaking of a region

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Summary

Introduction

The political reorganisation of health and care is both temporal and spatial. Health policy scholars commonly incorporate a longitudinal approach examining the former (for instance, Powell 2003). Where scholarship has engaged with the political construction of space shaping healthcare reform, there is a tendency for analysis to privilege a single spatial dimension as the definitive concept for examining historical or contemporary changes (Jessop et al 2008). This scholarship often responds to policy agendas which either explicitly or implicitly adopt geographic concepts such as place (Hammond et al 2017, Prince et al 2006), localism (Allen 2006) or community (Moon 1990). Studies tend to find the latest spatialised policy rhetoric often does not meet with reality

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