Simon Bishop and Justin Waring
Cutting ribbons on gleaming new buildings, politicians have long sought to bolster their public image through association with new facilities developed as the flagships of public service reform. ‘Out with the old and in with the new’ is the clearly intended message. But beyond rhetoric of ‘cutting edge design’ and ‘state of the art working’, there is very rarely any deeper conversations of how new buildings affect the lives of the employees and members of the public who use them daily. Even within more detailed deliberations over new facilities by planners and service managers, the focus tends to be on how new spaces are going to work functionally – cost, technical and ergonomic features of building projects are the predominant concerns.
In our Policy & Politics article, we look at the new spaces created by public service reform, not in terms of their functional efficiency, but through the way they are understood, used and, in some ways (re)made, by the various groups who spend time in them. Importantly for our work, recent public service facilities have often sought to bring together previously separate groups under one roof, as part of intended changes to service delivery. With emphasis on ‘networked’ and ‘joined up’ services, this includes bringing groups from the private and public sector together to engage in new forms of work. This could be seen as part of a wider fashion for ‘hybrid’ productive spaces, such as the ‘home-office’, ‘cafe-office’ or ‘online classroom’. But, we ask, how do people combine the different expectations, values and ways of acting implied by previous distinctions when using such hybrid spaces?
To start to answer this, our research looks at the development of new hybrid spaces in healthcare. Our ethnographic investigation focuses on a new Independent Sector Treatment Centre (ISTC), which was funded, designed, built and operated as a public-private partnership between the NHS and private companies. At the level of policy rhetoric, ISTCs were intended by policy to make (comparatively) straightforward healthcare treatments more efficient by re-organising service delivery based on private-sector manufacturing principles, provided under the NHS umbrella. As with many such policies, the realisation of ISTCs varied wildly; some ISTCs involved major new buildings, and some were existing NHS departments with different funding – and corporate logos – stuck on. This was a highly controversial policy initiative, and certainly led in some instances to a pretty shocking waste of public resources.
To explore what staff and service users made of the spaces created by the ISTC programme in more detail, we made use of Michael Foucault’s (1986) concept of heterotopia. Foucault broadly used the term to describe spaces in which different cultural expectations are brought together, and where accepted ways of doing things can be questioned and possibly upended. Although Foucault is seen by most people as someone pre-occupied with the way our lives are determined by existing powerful forces, the concept of heterotopia does appear to offer a way of seeing how certain spaces can lead to a reconsideration of existing power relations, resulting in instability and disorder. In our case, we draw on the idea of heterotopia to consider how people sought to adapt their understanding and use of the spaces of the ISTC, to take account of the potentially conflicting commercial and public healthcare ideals.
Our findings outline some of the ways that people went about working and receiving treatment within healthcare spaces that were in some parts similar to existing public hospitals, and in other parts looked more like places of consumption (like hotels and airports). From our examples, we suggest that such spaces did appear to open up some possibility of human agency, because they took away – or at least gave people cause to question – taken for granted ways of using the healthcare space. The commercial and consumer aspects of new healthcare facilities, alongside traditional markers of public healthcare, meant that people had to make choices about how they should act and what forms of interaction were appropriate. Taking this further, we discuss how such heterotopias might be seen as spaces in which social relations can be inverted or disrupted, not only because of the presence of incongruous elements within the physical space, but also because of the effort and agency involved in trying to accommodate and possibly reconcile the differing demands that different elements made on people.
While it is clearly the financial imperative that lies behind many cross-sector partnerships, new spaces created by them have implications for our lives and sensibilities beyond value for public money. Given the direction of public policy travel, we think that further consideration of how hybrid spaces are coming to dominate the public service landscape is now needed.
This blog post was originally published on the Discover Society – Policy and Politics blog on 6 February 2019.
You may read the original research in Policy & Politics:
Waring, Justin & Bishop, Simon (2018) ‘Transforming professional and service user identities in the heterotopian ‘hybrid spaces’ of public–private partnerships’, Policy & Politics, DOI: https://doi.org/10.1332/030557318X15333033267699
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