Competition and Contracting in the Transition from CCT to Best Value: Towards a More Reflexive Regulation?

Following publication of the government’s proposals for a statutory framework of Best Value, and the introduction of regulations increasing the flexibility of CCT pending its abolition, this paper examines the relationship between the compulsory regime and its likely successor. First, the paper suggests that the Best Value frame-work is likely to impose a range of regulatory, monitoring and enforcement constraints similar in effect to the formal requirements that operate under CCT. Continuity with Conservative policy will be reinforced practically through transitional arrangements for the gradual abolition of CCT and the phased introduction of its replacement. Second, the paper argues that contracting is likely to continue to have a significant role under the new regime as the natural adjunct to the voluntary competitive processes that will be the preferred management tools for securing improvements in service performance. Open tendering and public-private sector partnership arrangements, both of which imply contractual governance, are given explicit priority in the consultation document over benchmarking, performance indicators and other comparative public management mechanisms. Third, the paper argues that local authorities are likely to want to retain and develop contracting arrangements that potentially permit a degree of control over service provision that might not be available were more radical service-providing alternatives to be adopted, involving the complete transfer of functions outside the public sector and/or their vesting in independent companies. Finally, the paper assesses the transition from CCT to Best Value from the theoretical perspective of responsive and reflexive regulation. Following a brief account of the reflexive failures of CCT, the paper argues that, although the Best Value framework is characterized by inherently reflexive processes involving self-review, consultation and standard-setting, its relative success is likely to depend ultimately both on the tightness with which legislation is drafted and on the manner of its practical interpretation, implementation and enforcement.     

Increase in self-rejection and continuing/discontinued deviant response

It was hypothesized that adoption of deviant response patterns regardless of subsequent continuation of the act would be associated with an antecedent increase in negative self-attitudes. Subjects were seventh-grade students who responded to a questionnaire three times (T ₁,T ₂,T ₃) at annual intervals (N=3,148). Self-attitudes were measured by a seven-item self-derogation scale. Change in self-derogation was determined by expressing the posttest score as a deviation from the posttest-on-pretest regression line. Deviant responses were defined in terms of self-reports of each of 22 highly independent responses. In all cases, as hypothesized, for each of the 22 deviant responses both (1) subjects who adopted and continued the act and (2) subjects who adopted and discontinued the act manifested greater increases in self-derogation than subjects who did not adopt the deviant act. The differences, all of which were in the hypothesized direction, were significant in 34 of the 44 comparisons. The results were interpreted as supporting the position that the adoption of any of a broad range of manifestly dissimilar deviant responses is preceded by the genesis of negative selfattitudes.Received his Ph. D. in sociology from New York University in 1958. Current research interests are social psychiatry and, more specifically, the reciprocal relationship between self-attitudes and the adoption of deviant response patterns.     

Deviant behavior and self-enhancement in adolescence

The hypothesis that “among initially high self-derogation subjects deviant response patterns (alcohol and drug abuse, delinquent patterns, etc.) are related to subsequent decreases in self-derogation” was tested with data from a longitudinal survey study of adolescents. Among higher and lower socioeconomic status (SES) males initially high self-derogation subjects who adopted (relative to those who did not adopt) any of several deviant patterns manifested significantly greater subsequent base-free decreases in self-derogation. For higher SES females only narcotics use (and among lower SES females no deviant pattern) was significantly related to subsequent decrease in self-derogation. Together with collateral data, these results indicated that where the deviant patterns were compatible with valued social roles and the subjects were able to defend against negative responses by others (but not under mutually exclusive conditions), deviant patterns functioned to reduce self-rejecting feelings among initially highly self-derogating subjects.     

Looking Ahead: Addressing Ethical Challenges in Public Health Practice

Ethical challenges in public health can have a significant impact on the health of communities if they impede efficiencies and best practices. Competing needs for resources and a plurality of values can challenge public health policymakers and practitioners to make fair and effective decisions for their communities. In this paper, the authors offer an analytic framework designed to assist policymakers and practitioners in managing the ethical tensions they face in daily practice. Their framework is built upon the following set of six considerations: determining population-level utility of the proposed action; demonstrating evidence of need and effectiveness of actions; establishing fairness of goals and proposed implementation strategies; ensuring accountability; and, assessing expected efficiencies and costs associated with the proposed action. Together, these considerations create a structured guide to assist decision-makers in identifying potential ethical challenges and in assessing the moral considerations that underlie public health practice - and possibly even, if the conditions are met, reduce the creation of ethical tension. Although the authors'empirical experiences provide the basis for the framework advanced here, their approach remains to be tested and evaluated by public health practitioners.