Ambiguities and Complexities of Obtaining Value for Money in the National Health Service: Storytelling Approach

This thesis examines a quest for Value for Money in the United Kingdom National Health Service and argues that in spite of considerable achievements, the Value for Money approach has “crowded out” CARE. Essentially, CARE involves sympathy, empathy, and compassion. It has so many different manifestations in practice that a) it can only be shown through narratives, and b) this requires a more decentralised–bottom up–approach than has been adopted by the Value for Money strategy. We represent Value for Money as a Grand Narrative in the sense of Lyotard (1979, 1984), and treat it as a representation of the archetypal Net Present Value model.  To capture the idea of CARE, a story approach, which we summarise as multi-narratives, is adopted. The multi-narratives derived from interviews are deconstructed using panel data, further stories and Socratic Dialogue, including ongoing academic dialogues. Using an open-ended interview approach, we find that disparity exists between the Value for Money strategy as perceived by the strategy designers in one part of the National Health Service hierarchy (or network) and those implementing the same strategy in another. Asking people who implement strategies to tell individual stories that illustrate CARE will enhance the Value for Money strategy, and CARE can then become a route for enhancing the existing Value for Money strategy by placing value on the stories about the delivery of CARE. The framework of the approach emerges from a wide range of current and historic literature related to Value for Money, ranging from the models of Irving Fisher to postmodern and post-structural perspectives of deconstruction, narratives, Socratic Dialogue, Différance, and the presence of the ‘Other’.  You will find a copy of my thesis here: ZRINKA MENDAS THESIS 2010