The Usage of Scientific Knowledge by Independent Regulatory Agencies

The normative justification for delegation to independent regulatory agencies (IRAs) is that they operate by using technical analysis and expertise rather than political considerations in their decision‐making processes. Although delegation has been discussed as a design principle, systematic evidence on the conditions under which IRAs make use of scientific knowledge and how is still scarce. Scientific knowledge can be used to achieve instrumental learning, but also to seek legitimacy from the policy environment or to improve the agency's standing in the political games with the principal. This article will suggest how comparative empirical research can be usefully organized, by enriching delegation and organizational theories with the insights of the literature on knowledge utilization. Drawing on the methodological device of explanatory typologies, the article aims at shedding light on different types of knowledge utilization and the scope conditions that lead to a certain use of knowledge by IRAs.     

TACKLING HEALTH INEQUALITIES IN POST‐DEVOLUTION BRITAIN: DO TARGETS MATTER?

Since devolution in 1998, many aspects of public policy in Great Britain have diverged between England, Scotland and Wales, including how targets and performance assessment are used in the National Health Service and local government. Health inequality is an example where all three countries have recognized a need to act but approaches to performance assessment differ. Based on interviews with senior managers, the complexity of health inequality as an object of local intervention is explored and compared. Despite contrasting approaches to targets, local discourses in all three countries had significant similarities. Health inequality had to compete against a preoccupation with improving access to acute services generally and balancing budgets over the short term. There was a bias in the interventions described towards targeting health behaviours, but with limited use of evidence about efficacy, and indications that measuring progress with reducing health inequalities was starting to lead to an emphasis on ‘quick wins' from pharmacological interventions.     

UNDERSTANDING CHANGE IN THE NHS

This paper presents a novel and distinctive approach to the study of change within the NHS. Central to the paper's approach is the view that research on change in health care systems should be processual, comparative, pluralist, and historically based. Guiding such a view is a meta-analytical framework which contends that theoretically sound and practically useful research on change should involve the continuous interplay between ideas about the context , the process , and the content of change together with skill in regulating the relations between the three (Pettigrew 1985a, 1985b). The paper has five sections. Section one examines some of the contemporary pressures for change in the NHS and draws attention to the gap which often exists between statements of strategic intention and their operational implementation. Section two reveals our distinctive analytical approach to the study of service changes and clarifies the theoretical underpinnings of our work. Section three offers an extended critical review of recent research and writing on change in health care organizations. Section four summarizes our findings from the literature review and reaffirms the novelty and significance of our chosen approach. Section five provides an overview.