A critical systems evaluation of the introduction of a ‘discharge to assess’ service in Kent

Discharge to Assess (D2A) models of care have been developed to expedite the process of discharging hospital patients as soon as they are medically fit to leave, thereby improving the efficiency and effectiveness of the healthcare system. This article focuses on the implementation of a D2A model in Kent, England, which formed a case study for a European research programme of improvements in integrated care for older people. It uses the Critical Systems Heuristics framework to examine the implementation process and focuses in particular on why this improvement project proved to be so difficult to implement and why the anticipated outcomes were so elusive. The analysis highlights the value in using critical systems thinking to better evaluate integrated care initiatives, in particular by identifying more explicitly different stakeholder perspectives and power relationships within the system and its decision environment.

Dynamics of the policy environment and trauma in relations between Aboriginal and Torres Strait Islander peoples and the settler-colonial state

This integrative review seeks to employ insights from critical social psychology and Indigenous nation building governance research to advance an explanation for why Australian state policy continually fails to improve the lives of Aboriginal and Torres Strait Islander peoples and reproduces trauma. The review suggests that settler-colonial law and policy embed a history of oppressive relations that suppress Indigenous voice, culture, and identity, inexorably leading to intergenerational traumatic social and wellbeing outcomes for Indigenous peoples. Given settler-colonial policy’s ongoing role in continuing the subordination of Aboriginal and Torres Strait Islander law/lore, the ongoing policy failure to redress Indigenous inequality and improve their wellbeing is unsurprising. Nevertheless, our analysis contributes to understanding how just and viable relations between Australian Indigenous peoples and the settler-colonial state are possible through collaborative politics. Allowing space for agreement and disagreement in their worldviews, collaborative negotiations offer a way forward to redress policy failures and traumatic outcomes that are currently entrenched.

Diversity vs the 2030 agenda. A deconstructive reading of the United Nations agenda for sustainable development

This article analyses the marginal position cultural diversity is granted in the United Nations Agenda for Sustainable Development. Drawing on the work of Martin Heidegger and Jacques Derrida, it analyses and deconstructs the ontological assumptions of the UN's discourse. The inquiry shows that the ontological structure of the UN's agenda creates an essentialist and teleological understanding of history that privileges universality – unity – at the expense of diversity. In this way, the UN's plan of action reproduces what Ernesto Laclau defined as hegemony – a particularity assuming the representation of the totality. The 2030 Agenda naturalises the international power structure designed after World War II and presents it as beneficial for everyone. The article concludes that the 2030 Agenda's ontological assumptions create an inherently ethnocentric understanding of global issues.

Credibility contests: The contributions of experiential knowledge to radicalisation expertise

Radicalisation has become a highly influential idea in British policy making. It underpins and justifies Prevent, a core part of the UK's counter-terrorism strategy. Experts have theorised the radicalisation process, often beset by a weak evidence base and mired in fundamental contestation on definitions and explanatory factors. Experiential experts have been active contributors to these debates, presenting a challenge to the low-ranking role often given to experiential knowledge in evidence hierarchies and a contrast to policy areas in which it remains poorly valued. This paper draws on interviews with radicalisation experts to examine the dynamics of this pluralisation in practice. With a focus on credibility contests, it explains how experiential experts can claim authoritative knowledge and the challenges they face from those who prioritise theory-driven empirical data as the basis for contributions to knowledge. The paper draws out the implications for understandings of expertise of this newly conceptualised, evidence poor and highly applied topic area.

Regulating domestic and care work in Italy: Assessing the relative influence of the familistic model today

The domestic and care sector continues to display some problematic aspects due to its complexity, especially in terms of regulation. Italy represents a unique and peculiar case, where domestic and care work remains firmly under the purview of family management, and the work itself is entrusted mainly to immigrant workers. This paper aims to investigate, through in-depth interviews with representatives of both unions and employers’ associations, how the key actors involved in regulating domestic and care work intervene, understanding what kind of measures they take and what systems of relations/exchange exist among the different players involved in this process. The research sought to map strategies at a more macro level. While some of the actions undertaken by the social partners seem promising, there is still a lack of full responsibility for care at the public level, with marked asymmetries with respect to both services provided and working conditions.