Bringing Anglo-Governmentality into Public Management Scholarship: The Case of Evidence-based Medicine in UK Health Care

The field of public administration and management exhibits a limited number of favored themes and theories, including influential New Public Management and Network Governance accounts of contemporary government. Can additional social sciencebased perspectives enrich its theoretical base, in particular, analyzing a long-term shift to indirect governance evident in the field? We suggest that a variant of Foucauldian analysis is helpful, namely Anglo-governmentality. Having reviewed the literatures, we apply this Anglo-governmentality perspective to two case studies of post hierarchical UK health care settings: first, the National Institute for Health and Clinical Excellence (NICE), responsible for producing evidence-based guidelines nationally, and the second, a local network tasked with enacting such guidelines into practice. Compared with the Network Governance narrative, the Anglo-governmentality perspective distinctively highlights (a) a powerknowledge nexus giving strong technical advice; (b) pervasive grey sciences, which produce such evidence-based guidelines; (c) the subjectification of local governing agents, herein analyzed using Foucauldian concepts of the technology of the self and pastoral power; and (d) the continuing indirect steering role of the advanced neoliberal health care State. We add to Anglo-governmentality literature by highlighting hybrid grey sciences, which include clinical elements and energetic self-directed clinicalmanagerial hybrids as local governing agents. These findings suggest that the state and segments of the medical profession form a loose ensemble and that professionals retain scope for colonizing these new arenas. We finally suggest that Anglo-governmentality theory warrants further exploration within knowledge-based public organizations.