DECENTRALIZING HEALTH SERVICES IN THE UK: A NEW CONCEPTUAL FRAMEWORK

Decentralization is a central plank of current government health policy. However, it is possible to discern both centralist and decentralist movements in the UK. This paper examines existing frameworks of decentralization in relation to identifying whether policy is decentralist or not and identifies a number of problems that limit their value. Key problems relate to the way decentralization is conceptualized and defined. Existing frameworks are also highly contextualized and are therefore of limited value when applied in different contexts. The paper then presents a new framework which, it is argued, provides a more useful way of examining centralization and decentralization by providing a way of categorizing policies and actions and avoids the problems of being contextually constrained. The paper ends with a discussion of how the framework can be applied in a health context and shows how this framework helps avoid the problems found in previous discussions of decentralization.     

EMBRYONIC ASSOCIATIONALISM: NEW LABOUR AND URBAN GOVERNANCE

This article considers the role of ideas in New Labour’s approach to the governance of urban regeneration and characterizes this approach as ‘embryonic associationalism’. This approach contrasts with the economic rationalism of previous Conservative governments and leads to a more determined effort to empower local community groups within the policy process. We analyse the effects of this shift in approach in practice through a comparative case study of changing patterns of governance in different areas of the English city of Sheffield over a ten‐year period. We conclude that while other factors are important in shaping the nature of community empowerment, New Labour’s approach has promoted a political environment in which it is increasingly difficult for local state actors to ignore the voice of local communities. However, while we refer to this as ‘New Labour’s approach’, we are clear that this relates to a tradition of ideas that is far from new in Labour thought.     

DO NEIGHBORHOODS GENERATE FEAR OF CRIME? AN EMPIRICAL TEST USING THE BRITISH CRIME SURVEY*

For a long time, criminologists have contended that neighborhoods are important determinants of how individuals perceive their risk of criminal victimization. Yet, despite the theoretical importance and policy relevance of these claims, the empirical evidence base is surprisingly thin and inconsistent. Drawing on data from a national probability sample of individuals, linked to independent measures of neighborhood demographic characteristics, visual signs of physical disorder, and reported crime, we test four hypotheses about the mechanisms through which neighborhoods influence fear of crime. Our large sample size, analytical approach, and the independence of our empirical measures enable us to overcome some of the limitations that have hampered much previous research into this question. We find that neighborhood structural characteristics, visual signs of disorder, and recorded crime all have direct and independent effects on individual‐level fear of crime. Additionally, we demonstrate that individual differences in fear of crime are strongly moderated by neighborhood socioeconomic characteristics; between‐group differences in expressed fear of crime are both exacerbated and ameliorated by the characteristics of the areas in which people live.     

PUBLIC MANAGEMENT REFORM IN THE UK AND ITS CONSEQUENCES FOR PROFESSIONAL ORGANIZATION: A COMPARATIVE ANALYSIS

It is often assumed in the literature on public management reforms that radical changes in values, work and organization have occurred or are under way. In this paper our aim is to raise questions about this account. Focusing on three services in the UK, each dominated by organized professions – health care, housing, and social services – significant variations in the effectiveness of reforms are noted. The available research also suggests that these outcomes have been inversely proportional to the efforts expended on introducing new management practices. The most radical changes have been in housing, where, paradoxically, successive UK governments focused least attention. By contrast, in health and social services, management restructuring has been less effective, despite the greater resources devoted to it. This variation is attributed to professional values and institutions, against which reforms were directed, and the extent to which different groups became locked either into strategies of resistance or accommodation.