O'Connor, Jane Louise; (2025) State Governance, Complexity and Democratic Accountability: An Analysis of Health and Social Care in England. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Scholars have long debated the democratic implications of new state governance approaches on the representative democratic model, parliamentary sovereignty and the principle of ministerial accountability. The body of scholarship is both critical, concerned with accountability deficits related to the role of unelected actors in the public policy domain, and constructive, whereby established democratic structures are supported by new governance networks that enable citizen participation in processes of deliberation and accountability. The reality is more nuanced, as such this thesis offers a re-orientation of the debate to recognise the complexity of contemporary governance through an examination of the context and conditions of accountability within a highly salient area of public policy, health and social care in England. The thesis applies a distinctive model based on Qualitative Social Network Analysis (QSNA) and case studies. QSNA has been selected for its suitability analysing relational structures and dynamics in governance networks, and the case study approach allows for an in-depth, contextualized examination of how accountability processes and the associated relationships function in practice across three cases: the national health and social care governance system in England, and two local systems comprising Greater Manchester and South Yorkshire and Bassetlaw. The findings offer a nuanced perspective: the governance approaches examined both instantiate and undermine democratic accountability, a variability that is both context specific and characteristic of the non-linear nature of complex systems. The analysis reveals a complex governance network underpinned by dense webs of horizontal and vertical accountability relationships between multiple state and non-state actors, enacted across organisational and geographical boundaries, over time. Despite its complexity, the system is anchored via democratically legitimised bodies, and the presence of elected representatives in local systems. In its conclusion, this thesis explores ways in which the research framework and findings can inform future research and practice.

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