No contest: theorizing power through aspects of health and social care policy in the wake of the demise of the internal market in NHS Wales

Abstract

Following in the footsteps of Neitzsche (1968) and Foucault (1980), Clegg et al (2006) and Haugaard and Clegg (2009) have argued that power is the most central concept in the analysis of organization and organizing. The desirability of further developing the theorization of power in health and social care policy in the United Kingdom has been identified in a number of recent publications (Hunter, 2008; Crinson, 2009; Ham, 2009). This critical overview analyzes relative power to connect policy at the macro level (ending the internal market in NHS Wales) with specific policy issues encompassed by the four projects within the portfolio on: • locality commissioning; • delayed transfers of care; • governance, incentives and integration; and • safeguarding adults. The contribution to knowledge that flows from this critical overview: identifies that theorizing power in health and social care policy may help to explain apparent disconnections between policy intent and the effect of policy in practice in the context of post-devolution Wales; • suggests that, at its most extreme, neglecting to take into account the role of power in the design, implementation and review of policy in this particular policy arena becomes a matter of life and death; and • proposes that exploring power in health and social care policy through Foucauldian-informed critical discourse analysis of relative power could to some extent facilitate translation of policy aspirations into practice.