THE QUASI-MARKET,THE ENTREPRENEUR AND THE EFFECTIVENESS OF THE NHS BUSINESS MANAGER

The recent changes in the UK National Health Service were heralded by the publication of the Griffiths report in 1983 which highlighted the need for a business-like’approach to management. The policy makers’generic strategy of the late 1980s and early 1990s centred around the concept of‘quasi-markets’. These were artificial internal markets encompassing the purchasers and providers of public services. Little research has been undertaken into this new phenomenon of the‘quasi-market’but entrepreneurship economic theory would suggest that for markets to be efficient would require a supply of alert and aware entrepreneurs. Within the restructured NHS, the mantle for entrepreneurial management seems to have been placed firmly on the shoulders of the newly created‘business managers’. A 1993 survey amongst NHS business managers in first and second wave trust hospitals in the Trent Regional Health Authority indicated that whilst business managers were knowledgable of what entrepreneurial activity is, they currently feel constrained in their new roles for a variety of reasons. The authors suggest that rational economic analysis is insufficient to explain this lack of innovatory endeavour. Instead policy makers’attention should be devoted to liberating health managers from their current constraints to encourage their entrepreneurial development.     

PLANNING AND CONTROLLING PUBLIC EXPENDITURE IN THE UK, PART II: THE EFFECTS AND EFFECTIVENESS OF THE SURVEY

Part I of this article [spring 19921 examined and explained the processes by which the Treasury plans and controls public expenditure through the Public Expenditure Survey. This second part analyses the survey's effects and effectiveness. Throughout we assess the survey by the extent to which the principal functions of planning, allocating, controlling and evaluating public expenditure are articulated and performed. We use four sets of criteria. Firstly, the survey is assessed as a means of regulating the interdependent relationships of the principal participants. Secondly, as a system for making decisions about public expenditure, the survey is judged by the extent to which it has enabled governments to achieve their broad spending objectives. Thirdly, the survey is assessed b the extent to which it provides directly for the participation of ministers collectively in tie process of decision-making, and how they decide the relative priority of both the total of public expenditure and its composition. And fourthly, its effects are measured by analysing the outputs of the system - the allocation of spending to departments and agencies. In the concluding section we address directly the question of whose interests are best served by the survey.     

MANAGING EUROPE FROM AN IRISH PERSPECTIVE: CRITICAL JUNCTURES AND THE INCREASING FORMALIZATION OF THE CORE EXECUTIVE IN IRELAND

This article analyses the management of European Union (EU) business by the Irish core executive. More specifically, it investigates the demands placed by EU membership on the Irish system of public administration and how the system has responded to these demands. Employing an institutionalist analytical framework, the article maps the formal and informal organizational and procedural devices or structures used to manage EU affairs in Ireland, as well as dissecting the key relationships that govern this management process and the role of the domestic agents actively involved in the EU’s governance structure, the cadre or boundary managers. The article also explores in a dynamic way the development of the capacity for the management of EU affairs in Ireland over time. Using the concepts of path dependence and critical junctures, we illuminate how key system‐management decisions became locked‐in over time and we isolate the triggers for significant adaptational change, be they domestic or external. Adaptation to EU business in Ireland was path‐dependent and consisted of gradual incremental adjustment. This system of flexible adaptation generally served Ireland well as the EU’s policy regime expanded and evolved, but in response to the shock rejection of the Nice Treaty by the electorate in 2001, significant formalization of the Irish system occurred with the establishment of new processes and rules for managing relations between the core executive and the EU.     

THE EFFECTIVENESS OF RELATIONAL CONTRACTING IN A TEMPORARY PUBLIC ORGANIZATION: INTENSIVE COLLABORATION BETWEEN AN ENGLISH LOCAL AUTHORITY AND PRIVATE CONTRACTORS

This article evaluates the factors that shaped the effectiveness of three strategic contracts pursued with private firms by a local authority in the English West Midlands. The contracts generated highly political outputs that supported the council’s defence of the core interests of local residents. The analysis explores the form taken by the contracts; the mechanisms that delivered and integrated them; and the wider structural factors that helped to secure apparently benign contractual outputs. The evaluative yardsticks used to support the analysis were: relationality; flexibility; and performativity. The article argues that relationality is crucial in determining quality in temporary, project‐based organizations. Relationality yields flexibility and effective performance, based on mutual regard and loyalty. The case study highlights the need to explore perceptual gaps between the parties; the importance of the time‐path of relationality; the significance of ‘value residuals’ in incentivizing substantive loyalty; and the potential contribution of zones of flexibility to performance.     

NETWORKING LITERATURE ABOUT DETERMINANTS OF NETWORK EFFECTIVENESS

Since the early 1990s, public networks have been implemented in many countries to solve ‘wicked’ public problems, addressing such issues as health, social care, local development and education. While considerable research has been carried out into public networks, both managers and scholars are left with some doubts about network effectiveness. In fact literature on this topic has been highly fragmented, comprising a plurality of definitions, multiple theories, multiple methods and multiple explanations. This paper aims to review and classify previous theoretical and evidence‐based studies on network effectiveness and its determinants. Our aim is to rearrange existing literature into a unitary framework in order to shed light on both hitherto unfilled gaps and established theoretical cornerstones.     

THE UNITARY STATE AS A SYSTEM OF CO-GOVERNANCE: THE CASE OF THE NETHERLANDS

The original institutional design of Dutch administration and intergovernmental relations is commonly referred to as the 'decentralized unitary state'. However, the views of traditional administrative theorists have been misrepresented. Hierarchy, uniformity and the separation and delimitation of layers of government are not, as often alleged, the theoretical underpinnings of the Dutch unitary state. Rather, classical theory emphasized interdependence, diversity and the dynamic interaction of relatively independent layers of government. This image suggests that Dutch administration does not need a greater separation of layers of government but better means for regulating conflict. It also suggests that the unitary state comes in several guises and cannot be equated with a monocentric system of government.     

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.     

A TALE OF TWO CITIES: A CRITICAL EVALUATION OF THE GEOGRAPHICAL PROVISION OF HEALTH CARE BEFORE THE NHS

This article critically examines the state of knowledge with respect to the geographical provision of health care before the national health Service (MIS). Most accounts claim that health care was geographically unequal and/or inequitable. On closer examination, however, the claims of these studies appear roblematic. This is due to problems of the sources of data, intretation of the data, anz one writefs assertion becoming a subsequent writer's 'fact'. The xarges of inequality and inequity are critically examined. Then, for the hospital services, the situation is explored using data from a well respected but underutilized national wartime survey. Finally, an attempt is made to comare the degree of geographical inequality before the NHS with that of today. It is conclugd that the degree of inequality before the NHS is not as great as some conventional wisdom would suggest. Therefore, if the charges against the pre-NHs system are to stand, more evidence will be needed.     

A PROLEGOMENON TO THE STUDY OF THE ROLE OF RHETORIC IN THE GARBAGE-CAN POLICY PROCESS: THE CASE OF HONG KONG'S POSITIVE NON-INTERVENTIONISM

This article analyzes the Hong Kong government's policy making process from the garbage-can perspective. Despite the official claim that the principle of positive non-interventionism has been consistently adhered to, Hong Kong policy makers have been strategically employing positive non-interventionism as rhetoric in legitimizing what they choose to do or not to do in an ad-hoc manner. As a result, be it under colonial rule or Chinese sovereignty, Hong Kong has been governed like an “organized anarchy.” Indeed, playing with the rhetoric of positive non-interventionism has become the identity of Hong Kong policy makers. This argument is illustrated with a review of Hong Kong's industrial policy making from the pre-war period to the present.     

A COMMENT ON ADAMS AND BALFOUR: DIGNITY VIOLATIONS,AN ALTERNATIVE VIEW OF ‘ADMINISTRATIVE EVIL’

The major focus of Adams and Balfour’s article in this volume is on what they call ‘administrative evil’ where ‘evil’ is not intended but somehow inherent in modern ‘technical rationality’. Adams and Balfour draw inspiration from Bauman’s (1989) work and, further, use the interesting metaphor that administrative evil is ‘masked’. This means it is difficult to recognize – unlike intentional evil which is ‘unmasked’, that is, readily recognized. Common to both forms is that ‘evil’ implies ‘depriving of humanity’ or to ‘make someone suffer’, and there is no reason to question this. A basic aim of the article is thus to draw attention to ‘masked evil’, phenomena Adams and Balfour believe are insufficiently attended to. There is a broad variety of problems which Adams and Balfour do not touch on but which more or less appropriately can be subsumed under the label ‘masked evil’. Adams and Balfour mention a continuum according to degree of deliberation on consequences. There are, however, no examples given of acts which do not occur at any extreme of deliberation. A related point is that there are historical and cultural determinants of whether (and to what extent) we regard some forms of suffering as ‘evil’ or not.     

TOWARDS A EUROPEAN NERVOUS SYSTEM: THE ROLE OF THE ECONOMIC UNION

This article introduces the European Nervous System, a system of interoperable, networked, trans-European telematics applications linking public administrations in the Community member states. The reasons for its development are described, and progress to date outlined. The article also touches on its funding and management structures, and seeks to draw out some of the issues involved in the development of the ENS and the lessons to be learnt.