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Title: The rationality of rationing : a rhetorical policy analysis of deliberations about resource allocation in the NHS
Author: Russell, Jill
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2017
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The rationing of health care is one of the most politically sensitive and challenging issues facing policymakers today. Despite long-standing debate about how we should or might make rationing decisions, we still know surprisingly little about how such decisions are accomplished in practice. This thesis opens up the ‘black box' of rationing practices. It explores theoretically and empirically what it means for rationing decisions to be made rationally. My work challenges dominant conceptualisations of rationality in health policy, suggesting that rationing is inevitably and inextricably as much a social practice of deliberation and judgement, involving experiential knowledge, emotional engagement, and what Aristotle called ‘phronesis', as a technical process of applying research evidence and ethical principles, and following fair processes. I locate my research in the emerging fields of interpretive policy analysis and linguistic ethnography, and draw on sensitising concepts from rhetorical theory and Bakhtinian scholars to develop a novel approach to rhetorical policy analysis. My study is based on ethnographic observation of the deliberations of one priorities forum and three individual funding request panels of local NHS commissioning organisations. I explore close up the role of language and meaning making in these rationing groups, and demonstrate the ways in which they create their own ‘interpretive communities' within which rationality is locally constructed. My findings focus on four aspects of practice I identify as dilemmatic: the legitimacy of affordability as a guiding value of NHS health care, the emotionality of decision-making, the construction of some treatments as ‘low priority', and the role of lay people and ordinary knowledge in deliberations. My analysis exposes the ideological work of rationing discourse in defining the boundaries of what the NHS will fund, and shifting notions of entitlement to health care.
Supervisor: Greenhalgh, Patricia M. ; Shaw, Sara E. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available