THE FUTURE OF POLICE AUTHORITIES: MEMBERS VIEWS

Part of the argument about police accountability concerns the role of police authorities, their membership and powers. The Conservative, Alliance and Labour Parties have developed policies which are broadly retentionist – leave things as they are – reformist – change the membership – and radical – empower police authorities to determine policy. The evidence suggests that police authority members' views, though broadly consistent with their party policies nationally, differ in some important respects. Conservatives are increasingly unhappy about the statutory co-option of magistrates. Alliance members appear not to favour an increase in the proportion of nonelected members. And many Labour councillors entertain doubts about the control model.     

MOTIVES AND BEHAVIOUR IN DISTRICT HEALTH AUTHORITIES

With the advent of general managers in District Health Authorities, many members fear they will become the dignified element of the health service constitution, if this has not happened already. If the influence of members is to be retained (or regained) a better understanding of the causes of variations in the influence and effectiveness of members is important. These issues are examined from the perspective of the motives and behaviour of members themselves. Based on research carried out in six health authorities in 1984, a typology is developed which is shown to be useful in predicting the kind of members most likely to achieve individual influence within a DHA, and in diagnosing some of the reasons for differences in corporate influence between DHAs.     

TRANSFORMING PUBLIC SERVICES: CONTRACTING FOR SOCIAL AND HEALTH SERVICES IN THE US

Government contracting with private service organizations has grown rapidly in the United States in the last 25 years. Advocates of contracting hope that it will spur competition among service agencies, lowering costs and improving service quality. In practice, however, contracting departs significantly from this competitive model. Instead, government and private agencies develop long-term relationships which can be considered regimes governed by specific norms and expectations. These regimes profoundly influence the delivery of services and the politics of contracting. This article analyses these regimes in the context of the contested nature of public authority. The article concludes with suggestions for reforming public policy to improve the performance and effectiveness of contracted services.     

THE POLITICS AND MANAGEMENT OF HUNG AUTHORITIES

Hung local authorities have grown in numbers in recent years. This paper analyses the experience of those authorities. First it reviews the growing body of literature and argues that it has largely been concerned with particular authorities. The authors then proposed a research-based classification of hung authorities, before examining both the nature of political behaviour and changes in management. Finally, the paper identifies factors leading to stability and instability in hung authorities and the characteristics of both situations.     

COMPULSORY COMPETITIVE TENDERING FOR LOCAL GOVERNMENT SERVICES: THE EXPERIENCES OF LOCAL AUTHORITIES IN THE NORTH OF ENGLAND 1988-1992

This article examines the response of a sample of local authorities in the North of England to the introduction of Compulsory Competitive Tendering (Cm) following the 1988 Local Government Act. It analyses the Organizational implications of CCT and highlights how officers, councillors and trade union representatives viewed the changing nature of management within local authorities in the period following the award of the first service contracts. In particular, it examines the different reactions to the development of a more commercial approach to the management of services and ends by assessing the specific impact of CCT in the context of other important changes in local government.     

MEMBERSHIP OF THE ‘NEW STYLE’ HEALTH AUTHORITIES: CONTINUITY OR CHANGE?

The 1989 White Paper 'Working for Patients' continued the process begun by Griffiths of managerial reform and the introduction of private sector concepts into the NHS. One of the new proposals was to change the composition and constitution of health authorities, both to avoid the assumed weaknesses of the existing format and to emulate the pattern found in the private sector.
The essence of the change was the removal of the representational elements on authorities, both of medical professionals and nominees from the local authority. The health authorities were reduced in size to just eleven members and for the first time executives were included. Previous attempts at reform within the NHS have been judged to have resulted in more continuity than change. This article examines in detail who the new members are and assesses the balance between continuity and change.
Despite a high level of continuity of membership, there are signs of more fundamental change. There is a significant increase in the proportion of non-executive members from the private sector and with the inclusion of executives, a stronger managerial role is emerging. The article concludes by assessing what the implications of these changes maybe.     

INTERROGATING INSTITUTIONAL CHANGE: ACTORS' ATTITUDES TO COMPETITION AND COOPERATION IN COMMISSIONING HEALTH SERVICES IN ENGLAND

Since the beginning of the 1990s the public healthcare system in England has been subject to reforms. This has resulted in a structurally hybrid system of public service with elements of the market. Utilizing a theory of new institutionalism, this article explores National Health Service (NHS) managers' views on competition and cooperation as mechanisms for commissioning health services. We interrogate the extent of institutional change in the NHS by examining managers' understanding of the formal rules, normative positions and frameworks for action under the regime of the Health and Social Care Act 2012. Interviews with managers showed an overall preference for cooperative approaches, but also evidence of marketization in the normative outlook and actions. This suggests that hybridity in the NHS has already spread from structure and rules to other institutional pillars. The study showed that managers were adept at navigating the complex policy environment despite its inherent contradictions.     

QUALITY AND PUBLIC SERVICES

The issue of quality of service is becoming increasingly important in the public service as a result of new approaches that are being adopted to management, notably the development of contract-based management. The argument of this article is that the concept of quality is a particularly difficult one for the public services, because of problems of information asymmetries. The first sections of the article are concerned with the meaning of the concept of quality and the problems of managing quality in the service sector and the public service in particular. The central argument of the article is that there are important problems of information asymmetries between service providers and service consumers. Four different situations of differential information availability are distinguished. The article argues that the issue of quality in the public service is an inherently political one.     

FROM PROVIDING TO ENABLING: LOCAL AUTHORITIES AND THE MIXED ECONOMY OF SOCIAL CARE

Government policy seeks to introduce competition into the supply of social care through the separation of purchasing and providing responsibilities. A study of 24 local authority social service departments has explored the initial steps taken to prepare for the new enabling role, including the creation of a mixed economy of care. Very few were seeking to create a market in social care. Most argued that the inherent nature of social care rendered the introduction of service specifications and price mechanisms neither approriate nor feasible. Many authorities interpreted the enabling role in ways significantly different from that of the government. The study raises questions about the extent of local discretion in a context where the range of values and interests of implementing agencies may differ from those of the centre.     

RENEWING POLICY TO SUPPORT EVIDENCE‐BASED HEALTH CARE

Health systems internationally have developed policies to support evidence‐based health care (EBHC) for over a decade. As this article shows, the time is ripe to review current policy frameworks in an evidence‐based manner. We summarize key themes deriving from qualitative research on the UK EBHC implementation and draw out implications for policy renewal. Our diagnosis is different from current UK NHS (National Health Service) policy since we stress local capacity building rather than top‐down frameworks, standardized tools and guidelines. As other jurisdictions demonstrate alternative EBHC policy frameworks, more international comparison and mutual learning is needed.     

DECENTRALIZING HEALTH SERVICES IN THE UK: A NEW CONCEPTUAL FRAMEWORK

Decentralization is a central plank of current government health policy. However, it is possible to discern both centralist and decentralist movements in the UK. This paper examines existing frameworks of decentralization in relation to identifying whether policy is decentralist or not and identifies a number of problems that limit their value. Key problems relate to the way decentralization is conceptualized and defined. Existing frameworks are also highly contextualized and are therefore of limited value when applied in different contexts. The paper then presents a new framework which, it is argued, provides a more useful way of examining centralization and decentralization by providing a way of categorizing policies and actions and avoids the problems of being contextually constrained. The paper ends with a discussion of how the framework can be applied in a health context and shows how this framework helps avoid the problems found in previous discussions of decentralization.     

PUBLIC RESPONSIBILITY AND INEQUALITY IN HEALTH INSURANCE COVERAGE: AN EXAMINATION OF AMERICAN STATE HEALTH CARE SYSTEMS

This article examines the effect of the three publicness dimensions on inequality in health insurance coverage across 50 American state‐level health care systems. The analysis validates a Gini‐coefficient measure of Americans' unequal distribution of health insurance coverage across nine income groups and compares public ownership, financing, and control of health care systems across all 50 states from 2002 to 2010. There is a significant and negative relationship between public ownership and inequality in health insurance coverage, although the substantive impact of ownership is relatively small. Both public financing and control substantially reduce inequality in health insurance coverage across income groups. However, both of these must be present in order to be effective at reducing inequality. This article expands our understanding of the link between different institutional arrangements and inequality in health insurance coverage in hybrid health care systems.     

INTERAGENCY COLLABORATION IN HUMAN SERVICES: IMPACT OF FORMALIZATION AND INTENSITY ON EFFECTIVENESS

Interagency collaboration in human services production, it has been claimed, contributes to improved quality and/or reduced costs, but previous research on effectiveness from collaboration has failed to recognize that collaboration could be arranged in a multitude of ways. This paper investigates the effectiveness consequences of alternative collaboration arrangements. From a literature review, the degree of formalization and intensity, respectively, stand out as major aspects of collaboration. The impact on effectiveness from intensity and formalization was investigated through an explorative case study of collaboration projects in Sweden. Results suggest that the particular combination of formalization and intensity determines the impact on effectiveness. Combining low intensity with medium high formalization into ‘an assignments reallocation strategy’ of collaboration appears to have modest impact, whereas medium high intensity in combination with low formality, that is, ‘a commitment‐based networking strategy’, has a high potential to increase effectiveness. High intensity in combination with high formalization produces ‘a formalized team‐building strategy’, which is simultaneously promising and risky.     

ORGANIZATION AND NATIONALITY IN THE EUROPEAN COMMISSION SERVICES

Existing literature on the internal functioning of the European Commission services indicates that officials'nationality does have an impact on their policy-making behaviour. Students of western national administrations on the other hand, have found the geographical and social backgrounds of officials to be highly insignificant. However, given the unresolved tension between intergovernmentalism and supranationalism in the European Union, this seeming inconsistency may be understandable. In this article, an effort is made to specify some of the organizational and policy-related conditions under which nationality might be particularly important in order to understand decision behaviour. Interview data gathered from 38 Norwegian officials who had been seconded to the Commission are used to make an explorative appraisal of the assumptions put forth.     

CENTRAL REGULATION OF ENGLISH LOCAL AUTHORITIES: AN EXAMPLE OF META‐GOVERNANCE?

This paper discusses how the UK government has reconfigured its regulation of English local authorities by moving from direct oversight to using an indirect independent agency as a vehicle of meta‐governance. This theme is discussed through two strands: first, by examining how several factors eroded central government’s capacity to directly regulate councils. The second strand examines the strategies used by the Audit Commission, an independent agency, to assert its authority over councils and how its hegemony is sustained by facilitating and participating in horizontal and vertical networks across government, specialist policy and stakeholders’ communities.     

THE THEORY AND PRACTICE OF MANAGED COMPETITION IN THE NATIONAL HEALTH SERVICE

This article presents qualitative and survey evidence on the implementation of managed competition in the NHS. After outlining the economic analysis of quasi-markets made by Le Grand and Bartlett, Part I argues that a framework derived from organization theory is a more fruitful way of analysing and understanding behaviour at local level. Part II describes the experience of implementation in four district health authorities, concentrating on the way key actors conceptualized market relations and the way market imperfections were addressed. Part III discusses the main reasons why implementation took the form it did and the factors shaping similar or dissimilar responses.     

CHANGE IN THE MANAGEMENT OF PUBLIC SERVICES

This article identifies the main themes in recent changes in public sector management and shows the extent of the challenge to past organizational assumptions. While recognizing the objectives of the changes could bring benefits if realized, it argues that there are a series of issues that are unresolved. The language of consumerism, the development of government by contracts, the form of performance management and the use of quasi-markets are seen as creating problems. These are seen as deriving from an attempt to apply approaches drawn from the private sector to the public domain. It is argued that they need to be balanced by approaches that recognize the values of the public sector.     

COMPETITION OR MONOPOLY? COMPARING PRIVATIZATION OF LOCAL PUBLIC SERVICES IN THE US AND SPAIN

Differences in national traditions of public intervention, institutional arrangements and public service markets make local public services an area of great diversity. In this paper we undertake a comparative study of how local governments arrange for delivery of water and waste services in the US and Spain. We find levels of privatization are higher in Spain than in the US. We review organizational reform in the two contexts and compare service delivery data using national surveys from each country. We find lower and less stable privatization in the US stems in part from adherence to public choice emphasis on the benefits of market competition over public monopoly. By contrast, Spanish municipalities reflect an industrial organization approach, and create hybrid public/private firms which benefit from both market engagement and economies of scale available under monopoly production. We conclude that managing monopoly may be more important than competition in local service delivery.     

THE LIMITS OF KNOWLEDGE MANAGEMENT FOR UK PUBLIC SERVICES MODERNIZATION: THE CASE OF PATIENT SAFETY AND SERVICE QUALITY

This article assesses the contribution of management of knowledge across organizational and professional boundaries towards improved public services. We empirically investigate the potential for knowledge sharing within the context of the NHS modernization agenda, taking as our focus the current ‘patient safety’ policy agenda. Specifically, we evaluate the introduction of a knowledge management system, namely the National Reporting and Learning System (NRSL) and its impact in the area of operating theatres within a university teaching hospital. We suggest that government policy in this area needs to reflect more upon limits to the management of knowledge and issues of the nature of knowledge, professional cultures and institutional power and politics.