DENTISTRY AND MANAGEMENT OF THE NATIONAL HEALTH SERVICE: 1974–1982

The paper examines some inter-relationships between dentistry and the national health service, particularly the way in which it was slotted into the management arrangements in 1974. The aspirations of dentists during the pre-1974 period are compared with government intent and the management structure achieved. Analysis of the managerial or officer structure at each level of the service highlights the ways in which the patterns laid down for dentistry varied from the norm. Dentists' expectations and the officially declared intent were seldom synonymous; both were very different from the final system. In some ways dentists lost out in relation to the management arrangements. Their major organization was at area level rather than in the health districts. Whether or not this unusual structure was to the disadvantage of the profession and of dental care, time alone would have told. However, no such assessment is now possible. In April 1982 area health authorities disappeared: area dental officers have therefore been abolished.     

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.     

SHOULD THE NATIONAL HEALTH SERVICE HAVE AN INFORMATION STRATEGY?

The National Health Service (NHS) Review committed the NHS to the development of sophisticated information management processes and to the creation of a massive information technology infrastructure, and the success of the new arrangements depends critically upon progress in these two areas. Yet the NHS has a modest track record in both, which the period since the review has served only to highlight. The article examines the political environment in which information is exchanged and technology implemented, in order to explain the current state of play and the likely pace and direction of future developments. In particular it focuses upon the role of the NHS Management Executive in influencing these developments, and argues that success will depend on the extent to which national information policies encourage collaboration between key groups of managers and professionals and support the implementation of contracts for health services.     

‘LEADERISM’: AN EVOLUTION OF MANAGERIALISM IN UK PUBLIC SERVICE REFORM

This paper argues that ‘leaderism’– as an emerging set of beliefs that frames and justifies certain innovatory changes in contemporary organizational and managerial practice – is a development of managerialism that has been utilized and applied within the policy discourse of public service reform in the UK. The paper suggests that ‘leaderism’ is an evolution of entrepreneurial and cultural management ideologies and practices. An analysis of the articulation of leaderism with public service reform in the UK is presented. The paper problematizes the construals of leadership contained within these texts and reflects on their promotion of leadership as a social and organizational technology. ‘Leaderism’ is argued to be a complementary set of discourses, metaphors and practices to those of managerialism, which is being utilized in support of the evolution of NPM and new public governance approaches in the re‐orientation of the public services towards the consumer‐citizen.     

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.     

POST‐ACCESSION POLITICIZATION OF NATIONAL EU POLICY COORDINATION: THE CASE OF SLOVENIA

This article focuses on how domestic and EU‐level political factors affect the functional aspect of the national coordination of EU affairs. Due to the idiosyncrasies of the post‐communist countries which have joined the EU since 2004, an analysis of dynamic changes in the national systems of coordination needs to focus on three factors: (a) functional pressures from the EU; (b) the consolidation of the national party system; and (c) existing traditions of politico‐administrative relations. The international economic and financial crisis is considered as a fourth factor that has affected the first three factors through the increase in the EU's 'informal intergovernmentalism', which adds to the politicization of EU matters. The Slovenian case points to an increased, though selective, politicization of EU business due to both national‐ and EU‐level factors.     

THE NATIONAL COORDINATION OF EU POLICY IN HUNGARY: PATTERNS OF CONTINUITY AND CHANGE

Although European Union (EU) membership generates similar functional pressures for national administrations, member states developed institutional arrangements that show marked cross‐country variation in the coordination of EU policy. This article examines and assesses the institutions and mechanisms established in Hungary for formulating policy positions on the domestic level. In line with the general features of central government, the system is highly centralized and hierarchical, and has been characterized by a comprehensive coordination ambition from its inception. The case confirms the primary importance of national institutional factors for shaping coordination systems, but also the relevance of more actor‐centered explanations for accounting for changes in the top decision‐making tier. At the same time, the Hungarian experience also draws attention to power relations within governing parties and prime ministerial involvement as important variables so far relatively neglected in the literature.     

THE POLITICAL REVERSIBILITY OF ADMINISTRATIVE REFORM: A CASE STUDY OF THE UNITED STATES POSTAL SERVICE.

Studies of administrative reform have neglected or underestimated the tenacious nature of opposition. Vested interests first seek to obviate reform and, if unsuccessful, force reversion to the initial status quo. Such nullifying behaviour is discussed and illustrated with a case study of the incorporation of the United States Post Office Department.     

MEASURING NEED IN THE NATIONAL HEALTH SERVICE RESOURCE ALLOCATION FORMULA: STANDARDIZED MORTALITY RATIOS OR SOCIAL DEPRIVATION?

All methods of dividing public expenditure between competing claims become contentious, particularly when they rely on social indicators of need. The Resource Allocation Working Party (RAW) formula devised in 1976 for distributing National Health Service financial resources fairly between different parts of England relies on the size, age/sex structure and mortality rates (in the form of standardized mortality ratios – SMRS) of populations as combined surrogates for their need for health care. This paper aims to demonstrate three things: first, that RAW'S approach in selecting SMRS was sure-footed; second, that no better proxy of health care need which could be used in RAW has been produced since RAW; and third, that the continuing criticism of SMRS has been sustained by political pressures within the NHS. The result has been the application of ever more indirect and complex surrogates for'need in the resource allocation process which are known to be contaminated by the prevailing unequal supply of health service facilities.     

NEW MODES OF CONTROL IN THE PUBLIC SERVICE

Controversy exists regarding whether recent changes in the organization of the public services in the UK and elsewhere constitute a paradigm shift towards a post-bureaucratic form. This article argues that in Britain three fundamental but interlocking strategies of control have been implemented over the last decade. First, there has been a pronounced shift towards the creation of operationally decentralized units with a simultaneous attempt to increase centralized control over strategy and policy. Second, the principle of competition (often attached to the development of market relations but sometimes not) has become the dominant method of co-ordinating the activities of decentralized units. Third, during the most recent period there has been a substantial development of processes of performance management and monitoring (including audits, inspections, quality assessments and reviews), again a phenomenon largely directed towards operationally decentralized units.
Taken together these three strategies do not describe a simple movement from a bureaucratic to a post-bureaucratic form, rather they combine strong elements of innovation with the reassertion of a number of fundamentally bureaucratic mechanisms. This may be a peculiarly British phenomenon, certainly the excessive elements of centralization and formalization appear to depart from the ideal-type of the post-bureaucratic organization. It is argued that this'British trajectory'can best be understood in terms of the continued relative decline of the British economy and the Conservative response to it, i.e. the drive to create a'high output, low commitment'workforce.     

POLITICS BY HEURISTICS: POLICY NETWORKS WITH A FOCUS ON ACTOR RESOURCES,AS ILLUSTRATED BY THE CASE OF RENEWABLE ENERGY POLICY UNDER NEW LABOUR

Policy network analysis is criticized for being a ‘heuristic’ device, yet ‘heuristic’ methods may be essential to achieve detailed understandings of specific policy outcomes. Rational choice modelling alone cannot perform a similar function. This paper develops a ‘heuristic’ policy network approach that focuses on the analysis of actor resources. Changing contexts can alter the resource distributions of actors within a policy community. This can lead to new policy outcomes. Policy networks can therefore be rescued from criticisms made by, for example, Dowding, by re‐visiting Rhodes's earlier emphasis on analysis of actor resources. This approach is illustrated in the case of UK renewable energy policy under the UK government of New Labour. Changing contexts have strengthened the resources of the main renewable energy interest groups to achieve higher targets and more technology‐specific means of financial incentives. The Renewable Energy Association has achieved legislation favouring feed‐in tariffs as is the practice elsewhere in Europe for small renewable generators.     

THE INSTITUTIONALIZATION OF EU AGENCIES: AGENCIES AS ‘MINI COMMISSIONS’

A stream of reviews that take stock of EU governance trends shows that the EU's governance agenda produces mixed results. EU agencies are part of the EU's search for new governance mechanisms. They have not proven to be a break with EU policy‐making processes – underpinning administrative stability rather than reform. This article explores the institutionalization of EU agencies. Using the case of the EU's human resources (HR) policy, it concludes that administrative details are important in order to understand the development of EU agencies turning into institutions. The influence of the EU's institutional environment on their operations is so strong that they must operate as ‘mini Commissions'. This tight control hinders their institutionalization.     

THE DEVELOPMENT OF THE THATCHER GOVERNMENT'S 'GRAND STRATEGY' FOR THE CIVIL SERVICE: A PUBLIC POLICY PERSPECTIVE

Since the Thatcher Government came to office, the policies which it has pursued towards the civil service have been characterized by its determination to emphasize political control over the work of government departments and to'de-privilege' the civil service. The paper traces and evaluates the development of the Conservative Government's'grand strategy' for the civil service which was eventually given the form of the financial management initiative in 1982, an attempt to universalize MINIS and institutionalize Raynerism. Among other things, this policy study considers the cuts in civil service numbers and the changes in its hierarchy, the dismantling of the Priestley pay system, the civil service strike of 1981, and the disbanding of the Civil Service Department, involving as it did the dismissal of the Head of the Home Civil Service.