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


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.

Publication DOI: https://doi.org/10.1177/0261018314545599
Divisions: Languages & Social Sciences > Sociology and Policy
Languages & Social Sciences
Languages & Social Sciences > Aston Centre for Europe
Languages & Social Sciences > Centre for Critical Inquiry into Society and Culture (CCISC)
Uncontrolled Keywords: discourse theory,health care integration,logics,marginalisation,nodal analysis,Political Science and International Relations
Full Text Link:
Related URLs: http://www.scop ... tnerID=8YFLogxK (Scopus URL)
http://csp.sage ... content/35/1/45 (Publisher URL)
PURE Output Type: Article
Published Date: 2015-02
Published Online Date: 2014-09-01
Authors: Glynos, Jason
Speed, Ewen
West, Karen ( 0000-0002-9071-8002)



Version: Accepted Version

Export / Share Citation


Additional statistics for this record