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Title: Service user agency and the policy process : A case study of the Mental Health National Service Framework in England
Author: Newbigging, Karen Vanessa
Awarding Body: University of Leeds
Current Institution: University of Leeds
Date of Award: 2013
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Policy is often conceived of as a top-down process but post-positivist conceptions view formulation and implementation in a dynamic and recursive relationship. The Mental Health National Service Framework (MH-NSF) provided a research opportunity to explore this relationship. Published in 1999, the MH-NSF aimed to improve the mental health system and reduce variations in quality and access. It included a conception of the change process, which recognised the value of experiential knowledge and sought to promote service user agency. The aim was to understand the policy-action dynamic. I employed a conceptual framework of the policy process, as involving a recursive relationship between policy-in-intention, policy-in-implementation and policy-in-experience, and applied this to examine the evolution of the MH-NSF at a national and local level. Drawing on a qualitative, interpretive methodology, I used a multi-method research design involving two phases. Phase one adopted a Theory of Change (TOC) approach using documentary analysis and interviews with actors involved in policy formation to explore conceptions of the policy process, how changes were intended to be secured and how service user agency was expressed in policy intentions. Phase two focused on the policy process, using multiple methods to build a picture of changes in structure, practice and service user agency. The focus for the analysis was the dynamic relationship between formulation and implementation through the lens of service user agency. The MH-NSF had meaning at two levels: a narrow approach, directed at changing services to deliver NHS Plan targets through incentivising the local system; and a broader approach, concerned with promoting service user agency. The evolution of the policy process was situated and contingent on contextual factors but in relationship with the policy process at a macro-level and it was possible to identify configurations of conditions that facilitated or inhibited service user agency at an individual or collective level.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available