THE DONOUGHMORE REPORT IN RETROSPECT

The Report of the Committee on Ministers' Powers which appeared in 1932, was principally concerned with problems of subordinate legislation and formal administrative adjudication. Against a background of Dicey's views on parliamentary sovereignty and the Rule of Law, the Committee explored a variety of issues and made numerous proposals. In this article an attempt is made to consider why the Committee was appointed and what has happened since 1932. Particular reference is made to the Report of the Committee on Administrative Tribunals and Enquiries which appeared in 1957. The Reports of 1932 and 1957 are important in identifying significant developments in administrative law during this century.     

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.     

INTERROGATING INSTITUTIONAL CHANGE: ACTORS' ATTITUDES TO COMPETITION AND COOPERATION IN COMMISSIONING HEALTH SERVICES IN ENGLAND

Since the beginning of the 1990s the public healthcare system in England has been subject to reforms. This has resulted in a structurally hybrid system of public service with elements of the market. Utilizing a theory of new institutionalism, this article explores National Health Service (NHS) managers' views on competition and cooperation as mechanisms for commissioning health services. We interrogate the extent of institutional change in the NHS by examining managers' understanding of the formal rules, normative positions and frameworks for action under the regime of the Health and Social Care Act 2012. Interviews with managers showed an overall preference for cooperative approaches, but also evidence of marketization in the normative outlook and actions. This suggests that hybridity in the NHS has already spread from structure and rules to other institutional pillars. The study showed that managers were adept at navigating the complex policy environment despite its inherent contradictions.