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Title: The Merseyside Health Action Zone : a case study in the implementation of an area-based public health policy
Author: Povall, Susan Lesley
ISNI:       0000 0001 3497 4741
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2005
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Background: Health Action Zones (HAZs) were in the vanguard of the U.K. New Labour government health policy and existed between April 1998 and March 2003. They were area-based initiatives charged with the two aims of reducing health inequalities and contributing to the modernisation of services. The HAZs were aimed at areas of deprivation and were based on partnerships between local government and the local health sector. They were subjected to a barrage of changes both internally, through changes to their focus and funding, and externally, through organisational changes within their core partner agencies. Objective: The research examined "What has been the experience of implementing the HAZ policy on Merseyside?" from the perspective of those people involved with the development and delivery of the policy in Merseyside, people whose voices are rarely heard. It had the specific objectives of: a) to explore how central government interacted with the local implementation of MHAZ; b) to identify aspects of central government policy that facilitated or hindered local implementation; c) to identify what factors, if any, helped to make the horizontal relationships within the MHAZ operation work. Methods: The research contributes to the emerging field of policy ethnography. A case study ethnographic methodology was employed, adopting the qualitative methods of observation, semi-structured interviews and documentary analysis. The empirical data was collected between October 2000 and September 2003, mostly through the interviews. An iterative, thematic analysis was used to develop the findings. Main results: There are three key findings. Firstly, the persistent and rapid changes in the policy context had a detrimental impact on both short-term stability and the long-term security of the MHAZ. Secondly, the HAZ Way of Working, a whole systems approach, created a flexible, supportive environment for change. The HAZs had a specific set of values at their core and these values resonated with people connected with the MHAZ, releasing energy and enthusiasm. Thirdly, people are the means through which policy is implemented and change occurs. Conclusions: The findings highlight a tension in two change management processes operating within the MHAZ: a collaborative, flexible, whole systems approach to local change and a prescriptive, burdensome, top-down attempt to force change in the public sector. They reveal two different value systems operating against each other and reflect the paradox at the heart of the New Labour Third Way. Specifically, the findings lead to the following conclusions: people operate according to a set of values and policy implementation works best when it is in line with these values; MHAZ demonstrates the potential of joining-up locally, but this joining-up does not extend vertically between the central government and local implementation; to effect the lasting change that New Labour desires it needs to bring these two together to create a supportive environment for change with a common set of values.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral