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Performance Assessment and ‘Wicked Issues’: the case of health inequalities


The research is funded by the Economic and Social Research Council (ESRC) as part of a programme entitled Public Services: Quality, Performance and Delivery. It is led by Durham University in collaboration with the Health Services Research Unit, University of Aberdeen, and the School of Social Sciences, Cardiff University. The principle investigator is Tim Blackman, from the School of Applied Social Sciences at Durham University. Within CISHE Gareth Williams and Eva Elliott are undertaking the research in Wales.

Aims of Project

This three year national study aims to explore the effectiveness of different approaches to monitoring, assessing, and improving the work of public services in tackling ‘wicked issues’, using the current priority to reduce health inequalities as an example. ‘Wicked issues’ are described as complex issues that require different public services to work together, often without a clear understanding of causes and how outcomes can be best achieved.

The research will evaluate the contribution of performance assessment to making progress with health inequalities in three contrasting national audit cultures: England, Scotland and Wales. Using semi-structured in-depth interviews and discourse analysis the study will be undertaken in nine localities; four in England, two in Scotland and three in Wales. Participants will be selected across local authorities, Local Health Boards or Primary Care Trusts, key relevant community and voluntary organisations, and health partnerships spanning strategic, middle management, operational and community levels. Regional and national representatives will also be approached. Initial interviews are being conducted in the first year of the project with follow-up after around 18 months.


Economic and Social Research Council. Performance Assessment and Wicked Issues: the Case of Health Inequalities.(Blackman T.J PI, with Hunter D.J, Marks L, McKee L and Williams G.H)

Project Value




Additional Information

For further information see:

For a full list of projects at the Cardiff Institute of Society, Health and Ethics see: