GENERAL MANAGEMENT IN THE NHS: THE INITIAL IMPACT 1983–88

The Griffiths report of 1983 resulted in radical changes (to which the label 'general management' has been applied) to the formalities of organization and management in the national health service. We report the findings of a major study (involving more than 300 interviews) of the impact of these changes up to 1988. Although general management has been widely accepted in the service, and seems to have resulted in some improvements to management processes, there has been no substantial change in organizational culture. We conclude that the impact of the Griffiths model of management has been limited in comparison with the continued influence of medical autonomy and financial limitations.     

EVALUATING THE BREADTH OF POLICY ENGAGEMENT BY ORGANIZED INTERESTS

This article probes the variation in the breadth of policy engagement among organized interests. The literature, heavily shaped by large‐n US studies of Washington and its lobbying system, suggests many reasons for organized interests to focus policy engagement relatively narrowly. This claim of policy specialization has been long repeated in the British public policy literature. The aim of this article is to empirically test the extent to which expectations of narrowed engagement hold in a UK context. This article uses a new Scottish dataset that tracks actual engagement by any organized interest on executive policy consultations over a 25‐year period. It tracks over 90,000 ‘mobilization events' by over 18,000 organizations in 1,690 distinct consultation issues across the entire Scottish policy system. In analysing these data, we concern ourselves with establishing: (1) the extent of generalized engagement; (2) the type of organized interests that are more or less general in their engagement; and (3) the extent to which a specialized style of policy engagement is on the increase over time. In the process, we develop measures that are appropriate for assessing breadth of engagement using issue‐based policy data.     

THE LOCAL GOVERNMENT COMMISSION: EXAMINING THE CONSULTATIVE PROCESS

This article shows how a complex configuration of interests has shaped the work of the Local Government Commission for England ( lgc ). The article focuses upon the consultative processes associated with the work of the commission in Leicestershire and makes a dual contribution to our understanding of the emerging structure of English non-metropolitan local government. First, it provides a detailed insight into the consultative exercises carried out by one local authority, Leicestershire County Council ( lcc ), and explores the strategies employed by that authority in order to secure an optimal outcome from the Local Government Commission. Second, it argues that organization theory, notably the inter-organizational analysis applied by Leach in his work on the impact of the reorganization of local government in metropolitan Britain, offers the most pertinent theoretical framework for analysis. The article highlights the inadequacies of the consultation process around local government reorganization, showing that neither the efforts of the county council nor the commission itself stimulated a reasoned debate amongst the public. The review process did not capture people's imagination; nor did it stimulate genuine debate about the kind of local government we want. Essentially, what this article depicts is a picture of a pragmatic and brutal organizational battle in which there were losers as well as winners.     

The ambiguity of US foreign policy towards Africa

Since 9/11, the American policy towards Africa has been strongly influenced by national security interests and in particular by the fight against international terrorism and Islamic radicalisation. Traditionally, the American Africa policy has been the result of bureaucratic policymaking with the Pentagon and the State Department playing prominent roles. The paper argues that in the current century, evangelical Christian lobby groups have gained increasing influence on policymaking on Africa. Because policymaking has been influenced by a number of different actors, the American Africa policy may appear incoherent and ambiguous if judged narrowly on the expectation that it only aims to take care of US national security concerns and economic self-interests. The paper concludes that Africa was important to the United States during the presidencies of George W. Bush and Barack Obama because of the combination of strong security interests and strong domestic lobby groups that have pressured to place Africa on the US foreign policy agenda.     

SEEING THE FOREST FOR THE VILLAGE,NATION, AND PROVINCE: FORESTRY POLICY AND ENVIRONMENTAL MANAGEMENT IN EARLY-TWENTIETH-CENTURY YUNNAN

Abstract

This article compares village, national, and provincial forestry policy in early-twentieth-century China, with a focus on Yunnan, making three important observations. First, by identifying villages as key arenas for the production of forestry policy, it highlights the importance of rethinking the political geography of forestry policy during this period, to establish a proper comparative baseline for evaluating policy implementation. Second, its comparisons reveal diverging interests in forestry at these three levels, ranging from village reforestation for ecological conservation to provincial afforestation for economic development. Third, it shows that policymakers in these three arenas deployed distinctive cultural and political resources to promote their policies. The localized formats and objectives of village policies may have rendered them relatively invisible to national policymakers, who promoted more general and systematic forestry frameworks as novel interventions into a seemingly neglected policy arena that demanded comprehensive and intensive political intervention.     

POLICY-MAKING WITH A DIFFERENCE? THE TECHNICAL AND VOCATIONAL EDUCATION INITIATIVE

In this study we focus on the emergence of the technical and vocational education initiative. The formulation of the policy is found to differ from that of the conventional British policy style, in that it was announced without prior consultation with the education policy community. Further, overall responsibility for the initiative lies outside the traditional sphere of education — with the Manpower Services Commission. However, in the subsequent processing and implementation stages of the initiative, the established educational interests (local and national) are seen to move from the auditorium back to centre stage. The reasons for the original departure from the conventional policy style, those for the return to normality, and some implications, are examined.     

THE PARADOX OF POLICY DIVERSITY IN A UNITARY STATE: COMMUNITY CARE IN BRITAIN

Studies of policy-making and management in health and related fields have generally been confined to England even when professing to embrace Britain or the United Kingdom. The assumption of a unitary state in which the policy lead is given by Westminster/Whitehall is shown to be grossly misleading in the case of community care policy. Considerable variations exist not only in policy means but also in policy ends. The paper demonstrates the limitations of studying health and personal social services adopting a unitary state perspective. It argues for more intra-Britain comparative work aimed at evaluating the costs and benefits of service variations in different policy fields.     

CHANGING THE DECISION SPACE: EUROPEAN POLICY INFLUENCES ON ENERGY POLICY AND SYSTEMS CHANGE IN SWEDEN

The EU takes a growing interest in governing the energy sector in its member states. Competing with national institutions, policies and organizational structures, it is however not clear whether the EU exerts a strong influence compared to other factors, and if there is such an influence, the mechanisms are not well understood. This paper examines strategic reorientation towards electricity investment in the Swedish energy sector, a ‘frontrunner case’ of Europeanization, and discusses how this change can be attributed to EU policy change, national policy change and organizational field developments respectively. It finds that EU energy policy influence has been notable, and that governance mechanisms that shape beliefs and expectations are strongly at play. However, despite growing EU clout on energy policy, field level and national policy change remain key drivers of the changing decision space in the examined time period.     

AT A SNAIL'S PACE: ON THE LIMITED EUROPEANIZATION OF DOMESTIC CONSULTATION PRACTICES

Consultation of major interest groups is a widespread administrative practice in many EU member states. To date it is unclear, however, how advancing European integration influences domestic consultation practices. This article examines the impact of European integration on domestic consultation practices by conceptualizing how the underlying rationales of government–interest group interactions and the level of involvement of interest groups are affected by European integration. The study draws on original survey data on senior civil servants in Britain and the Netherlands to empirically examine these effects. European integration is related in a limited way to domestic consultation practices, both in Britain and the Netherlands. This small but significant effect is mostly observed during the process of domestic preference formulation in EU‐level policy making. Our findings suggest that intra‐organizational processes, for example organizational routines and task‐specialization, potentially play a greater role than has thus far been appreciated in Europeanization studies.     

FROM POLICY COMMUNITY TO ISSUE NETWORK: SALMONELLA IN EGGS AND THE NEW POLITICS OF FOOD

In the last two years the issue of food has been subject to increasing political controversy with firstly salmonella in eggs and later listeria and BSE becoming the focus of conflict and widespread media attention. This is an important change. In most of the post-war period food policy was conducted within a relatively closed policy community where issues concerning food policy were largely treated as routine technical decisions. The significance of the salmonella in eggs affair is that it is indicative of wider changes in the making of food policy. The increased activity of interest groups, the impact of the Common Agricultural Policy and changes in the retail economy have combined to transform the food policy community into an issue network.     

REPRESENTING CUSTOMERS’INTERESTS: THE CASE OF THE PRIVATIZED WATER INDUSTRY IN ENGLAND AND WALES

Privatization has been one of the most important and controversial policy initiatives to emerge in the UK over the last decade. However, to date there has been little attempt to assess the impact of privatization on customers, despite the fact that much of the justification for the privatization of the public utilities was couched in terms of the benefits it would bring for customers. In the case of the water industry opportunities for competition are virtually non-existent, and the ten regional water authorities were privatized with their monopoly position intact. Consequently customers’interests have been represented and protected through new regulatory arrangements operated by the Office of Water Services. The purpose of this article is to offer some provisional assessment of the effectiveness of these new regulatory arrangements. In doing so, the article regards the model of private sector consumer sovereignty as inappropriate given the continued absence of competitive arrangements for the representation of customers’interests against some of the criteria currently being discussed in the development of more consumer-oriented approaches to the delivery of public services.     

The framework convention on tobacco control: The politics of global health governance

This paper analyses the particular challenges that tobacco control poses for health governance in an era of accelerating globalisation. Traditionally, health systems have been structured at the national level, and health regulation has focused on the needs of populations within individual countries. However, the increasingly global nature of the tobacco industry, and the risks it poses to public health, require a transnational approach to regulation. This has been the rationale behind negotiations for a Framework Convention on Tobacco Control (FCTC) by the Tobacco Free Initiative of the World Health Organisation (TFI/WHO). In recognition of the need to go beyond national governments, and to create a governance mechanism that can effectively address the transnational nature of the tobacco epidemic, WHO has sought to involve a broad range of interests in negotiations. The contributions of civil society groups in particular in the negotiation process have been unusual. This paper explores the nature and effectiveness of these contributions. It concludes with an assessment of whether the FCTC constitutes a significant shift towards a new form of global health governance, exploring the institutional tensions inherent in attempting to extend participation within a state-centric organisation.     

Policy implications of the diffusion and control of medical technology.

Medical technology has become a controversial national policy issue, largely because of rapidly rising national health expenditures and their relation to medical technology. These costs are increasingly viewed in relation to benefits or effectiveness. Attempts to control medical technology, to consider benefits in relation to costs, have largely been regulatory, and have failed to ameliorate cost rises. This failure has stimulated consideration of the reimbursement system as a controlling device. The Medicare program already has developed a rather formal process for making reimbursement decisions based on technology assessments. However, fundamental reform of the reimbursement system seems necessary to counter perverse incentives built into payment. Recent proposals to shift to prospective payment is an example of such a change. However, the basically private nature of the health care system and the limited leverage of the Medicare program limits the power of the federal government to make change.     

Between Russia and a Hard Place: Great Power Grievances and Central Asian Ambivalence

Abstract

This essay asks how Central Asian states have responded to Russia’s intervention in Ukraine and salvos against the West, as a means to assess how Russia and the Central Asian states understand their national interests and exercise state power. It argues that the post-Soviet region shares a cynical and geopolitically driven view of the exercise of global power. Yet Russia has sometimes deployed its resources to advance short-term ideological objectives, whereas Central Asian foreign policy is pragmatic and opportunistic. The Ukraine crisis threatened to coerce the Central Asian states into conformity with Russia’s interests; ironically, their dependence on Russia has enabled their freedom of action in foreign policy, within limits. The essay highlights the ways that geography enables and constrains the execution of foreign policy, and considers the ambiguous role ideology plays in the formulation of national interests and the prospects for international cooperation.     

The health care state in the information age

The computerization of the medical record has important implications for the governance of health care, and the importance of health care means that changes wrought there are indicative of changes in government as a whole. This paper draws on work in public policy, medical sociology and studies of science and technology, as well as on cross–national empirical research in Britain and France. It describes the recent development of information policy in health care as an exercise in state–building, realized specifically in the governance of the health professions. The paper concludes with a discussion of what is both new and not so new in the form and extent of state power which emerges.     

REGIONAL GOVERNANCE IN ENGLAND: A CHANGING ROLE FOR THE GOVERNMENT’S REGIONAL OFFICES?

Debates about the appropriate territorial scales of government to meet the challenges of economic, political and social change have gained momentum in Western Europe in recent years. In the UK, political mobilization has transformed constitutional arrangements in Northern Ireland, Scotland and Wales. By contrast, in the English regions, a less radical approach has been adopted, but the outcome has been a strengthening of the institutions of regional governance. A key feature has been the enhanced responsibilities of the Government Offices for the Regions, which have been encouraged to build on their traditional administrative functions and adopt a more strategic role. This article explores the Offices’ contribution to regional and local governance. Our central argument is that although increasingly expected to act as a bridgehead between national and sub‐national government and a focus for regional policy coordination, their potential role in filling the missing gap in English regional governance has not yet been fully grasped.     

DOCTORS AND DEFICITS: REGULATING THE MEDICAL PROFESSION IN FRANCE

This paper seeks to analyze the political factors involved in health care delivery in a modern industrial welfare state and to illustrate how the transformation of the French state has affected the policymaking environment surrounding this particular issue. Cultural traditions rooted in the nineteenth century seriously circumscribed the role of the state in de-the conditions of medical practice. Nonetheless, pressures emerging since 1945 for the provision of a wide array of social services have drawn the state into ever closer regulation of the health sector. The economic constraints of the past decade resulted in state-imposed cost-containment policies which accentuated the trend toward politicization of health care. In consequence, and despite the rear-guard defensive tactics of the medical profession, the French state has succeeded in firmly establishing its primacy in this major area of public policy.     

LOCAL GOVERNMENT IN POLAND: EMPIRICAL INSIGHTS INTO THE PROCESS OF ENVIRONMENTAL POLICY

The subject of this investigation is the performance of Polish local government and its ability to make and implement environmental policy. The article proposes an assessment of national policy implementation based on policy outputs in the form of local policy programmes. National policy is implemented inter alia through elaboration, adoption and execution of environmental protection programmes at three subnational levels of self‐government. Self‐government is solely responsible for preparation and execution of the programmes. For every municipality, the rules for adoption including timetable, the structure of the draft, consultation of the draft and formal vote by local council to adopt the draft are the same. Therefore, the process of elaboration and adoption provides opportunity to compare municipalities across the country. Survey and interview based data from the study gives evidence about municipal performance in the programming and allows verifying possible influence of three macro factors on this performance.     

Politicized policy access: The effect of politicization on interest group access to advisory councils

Current scholarship often concludes that technical expertise is one of the most important commodities for interest groups wishing to gain access to political-administrative venues. Less attention has been given to politicization and the scope of societal support that interest groups bring to bear. Specifically, I hypothesize that the capacity of interest groups to supply broad societal support is decisive for gaining access in highly politicized policy domains. To test this expectation, the article combines a mapping of interest group membership in 616 Belgian advisory councils with survey data from more than 400 organized interests. The empirical analyses demonstrate that interest groups with broad support are more likely to gain access to advisory councils in highly politicized policy domains, but this effect is negatively moderated when interest groups involve their constituencies intensely in advocacy processes.     

Health care and AIDS

The acquired immune deficiency syndrome (AIDS) is a harbinger for change in health care. There are many powerful forces poised to transform the industrialized health care structure of the twentieth century, and AIDS may act as either a catalyst or an amplifier for these forces. AIDS could, for example, swamp local resources and thereby help trigger national reform in a health care system that has already lost public confidence. AIDS can also hasten the paradigm shift that is occurring throughout health care. Many of the choices society will confront when dealing with AIDS carry implications beyond health care. Information about who has the disease, for example, already pits traditional individual rights against group interests. Future information systems could make discrimination based upon medical records a nightmare for a growing number of individuals. Yet these systems also offer the hope of accelerated progress against not only AIDS but other major health threats as well. The policy choices that will define society's response to AIDS can best be made in the context of a clearly articulated vision of a society that reflects our deepest values.