Informing Debate or Fuelling Dispute? Media Communication of Reconfiguration in Scotland's Rural Maternity Care

Public reaction to the UK's ongoing health sector reform often results in dilution of policy‐makers’ goals. Public participation in health service decision‐making is advocated in policy, but precisely how to do it and what role public opinion should have in formulating reform strategy is ambiguously described. Public opinion is formed through many influences, including media reporting. This paper examines how reconfiguration at a rural maternity unit at Caithness General Hospital in Wick, Scotland, was communicated in national and local media and considers potential implications of media communication on public participation in policy decision‐making. Content analysis of arguments for and against change revealed a high level of reporting of commentators against change in regional newspapers. Qualitative analysis identified emergent themes about how maternity service reconfiguration was portrayed. These included framing opposition between management and local people, and change drivers receiving superficial coverage. Findings suggest that media portrayal of the public role in change may promote an adversarial rather than a participative stance. More finely tuned understanding of the relationship between the reporting of change and public reaction should be attained as this could affect how planned social policy evolves into actual practice.     

Why It Is Bad to Be Kind. Educating Refugees to Life in the Welfare State: A Case Study from Norway

In Norway, as elsewhere in Europe, the aim of policy‐making is to ensure the integration of immigrants into mainstream society. This paper focuses on one of the most concrete and practical measures Norwegian authorities have ever taken in this field, namely the recent establishment of a compulsory two‐year introduction programme for newly arrived refugees. This is an activation‐style programme involving both a financial and an educational component, where out‐payments depend on participation in a full‐time training programme aimed at enabling participants to become self‐sufficient members of Norwegian society. In the first part of the paper the establishment of this policy is located within a broader context of integration crisis, before it moves on to look more specifically at the background for the programme and the problems it is set up to address. The latter part of the paper addresses the implementation of the introduction programmes in one medium‐sized Norwegian city. The local discourse here is one of before and after, where the failings of previous policies have been overcome and new and productive practices have been established. Connections can be made between public and political discourses on integration crisis and the local discourses of implementation through the notion of kindness and the idea that kindness has hampered the integration efforts of the state. Herein lies a story not only about views on immigrants and diversity, but also about how immigration has challenged the Norwegian welfare state model.     

Pawns or Pioneers? The Logic of User Participation in Anti‐poverty Policy‐making in Public Policy Units in Belgium

Since anti‐poverty policy‐making in Belgium is embedded in a logic of user participation, social policy has shown interest in employing users with experience of poverty as experts in public policy units in order to implement and monitor anti‐poverty policies. In this article, we discuss this recent development as a relevant case for contemporary public service delivery in the European context. In the light of the ambiguous practices of user participation in Belgium, the enacted logic of involving service users in public service delivery is discussed, and potential risks and opportunities identified: do these individuals function as pawns or as pioneers? In search of opportunities for the implementation of anti‐poverty policies, we explore different ways in which public policy units can act upon the participation of employed service users in public service delivery. On the level of public service delivery, we argue that the participation of expert users risks their use as a mere blind, de‐responsibilizing those who work in public policy units in providing high‐quality services and being responsive to all service users including those living in poverty. On the level of these individual experts, we argue that the employed service users risk becoming pawns, acquiring a tragic‐optimistic outlook on life. We conclude that enabling service users to participate as pioneers requires the joint and mutual responsibility of the employed service users and those who work in public policy units for implementing and monitoring anti‐poverty strategies rather than exclusive responsibility assigned to individual service users.     

Putting the parity into service‐user participation: An integrated model of social justice

Models of service‐user participation have derived from citizenship or consumerist agendas, neither of which has achieved the structural reforms important for the most marginalised social work clients. This article proposes Fraser's model of ‘parity of participation’ as an appropriately multifaceted frame for capturing the social justice aspirations of service‐user participation. A qualitative case study compared the experiences and expectations of people who had used Australian mental health services with a sample who had used Australian homelessness services to examine their expectations of participation at individual and representative levels. The findings reinforce concerns from Fraser's research about the tendency for identity‐based consumerist notions of participation to reify group identity. This leads to tokenistic service‐user involvement strategies that have little impact on participation at a structural level. Fraser's parity of participation is shown to have untested potential to reshape service‐user participation to meet the social justice aspirations of social work clients. Key Practitioner Message: ● Innovative, service‐user driven strategies for collaboration will be those which challenge existing power structures; ● Service users want their contributions to decision making to generate identifiable change in the system of social services; ● The success of service‐user participation strategies might be the extent to which political, economic and cultural opportunities are enhanced.     

The Organization of Health Policy Functions in the German Federal Government

This article gives an account of the organizational history of the German federal ministry of health (and its predecessors) since the beginnings of public policy intervention in health care. In doing so it analyses the role of ministerial organization and examines the functional and political rationale underlying acts of reorganizing the tasks and resources of federal ministries. This analysis has two sides: the first concerns the expressive function of organizational form, as revealing something about the scope and perceived importance of the policy field, while the second interrogates the policy‐shaping role of organization and the political influence of the federal health ministry in health policy‐making. The article thus considers the organizational location of health issues in the central executive from the perspective of what it reveals about government goals and priorities. Then it examines possible policy implications. It looks at resources and the size of the ministry as a first attempt to learn something about the ministry's political weight. The question of policy implications draws our attention away from organization and resource allocation and back to a focus on policy‐making and policy outcomes. The final section therefore examines substantive policy implications that might have emanated from the organizational consolidation of the federal health ministry. It concludes that one such policy implication might be the erosion of the social insurance model as a regulatory idea in health‐care services and financing.     

Does Parental Participation in Schools Empower or Strain Civil Society? The Case of Community‐managed Schools in Central America

Among the various educational models in Latin America that seek to increase parental participation in schooling, perhaps the most far‐reaching is the experiment with self‐managed schools. These are publicly funded schools administered by parents. Broad public powers, such as the capacity to decide the budget and make staffing decisions, are given to parents, many of whom have had very limited prior administrative experience. How does this policy innovation impact on civil society? Does parental participation in school administration empower participating citizens or strain civil society? There are various ways of answering these questions. This article looks at some possible ways to conceptualize and assess the relationship between parental participation in self‐managed schools and civil society. The article draws from the experience of El Salvador, Guatemala, Honduras and Nicaragua, where these reforms have advanced significantly since the 1990s.     

Control or influence? Conflict or solidarity? Understanding diversity in preferences for public participation in social policy decision making

Participatory policy making is a contested concept that can be understood in multiple ways. So how do those involved with participatory initiatives make sense of contrasting ideas of participation? What purposes and values do they associate with participatory governance? This paper reflects on a Q‐method study with a range of actors, from citizen activists to senior civil servants, involved with participatory initiatives in U.K. social policy. Using principal components analysis, supplemented with data from qualitative interviews, it identifies three shared participation preferences: participation as collective decision making, participation as knowledge transfer, and participation as agonism. These preferences demonstrate significant disagreements between the key informants, particularly concerning the objectives of participation, how much power should be afforded to the public, and what motivates people to participate. Their contrasting normative orientations are used to highlight how participatory governance theory and practice frequently fails to take seriously legitimate diversity in procedural preferences. Moreover, it is argued that, despite the diversity of preferences, there is a lack of imagination about how participation can function when social relations are conflictual.     

Labour Force Participation,Social Inclusion and the Fair Work Act: Current and Carbon‐Constrained Contexts

The notion that employment is a precondition for personal wellbeing and social inclusion is almost sacrosanct in Australian culture. Yet, the working and living conditions of Australia's low paid workers tells a different story. While labour market participation is a cornerstone of the Federal Government's Social Inclusion Agenda, it is recognized that low pay and poor job quality often derail this key objective. Indeed, the difficulty of ‘making work pay’ at the bottom end of the labour market is a social inclusion challenge that has yet to receive the policy or public attention that it warrants. This article considers what the Fair Work Act means for the social inclusion of disadvantaged workers, in the context of wider‐ranging strategies to address low pay. It concludes with some considerations of the challenges that a carbon‐constrained economy is likely to present for labour force participation as a remedy for social exclusion.     

Co‐production in the epidemiological clinic: A decentred analysis of the tensions in community‐based,client‐facing risk work

Public health policies to prevent disease within populations are giving rise to shifting patterns of healthcare delivery in the late modern era. There is an inherent tension in modern medicine between evidence‐based standardisation, on the one hand, and patient‐centred specificity on the other. This tension manifests in recent policy narratives regarding public health risk (which we have characterised in terms of the epidemiological clinic) and co‐production. Drawing on co‐produced data with health trainers (lay health workers tasked with supporting behavioural change in patients at high risk of cardiovascular disease) in a deprived post‐industrial region of England, our decentred analysis focuses on three extended narratives from this data set. Our analysis builds on and develops emerging theories of risk work, informed by Habermas, and we explore the extent to which elite narratives of public health risk are resisted, absorbed, or bracketed off by client‐facing health workers—emphasising the heterogeneity of responses—and locate these responses within the context of the workers' employment conditions, their embodied experiences, and their wider beliefs and traditions. We argue that co‐production—albeit in a highly constrained form—is possible while delivering public health interventions. However, in the context of a community where health is so adversely affected by wider social problems and where task shifting has drawn lower status healthcare workers into these client‐facing roles, workers must find their own ways to negotiate and attempt to reconcile this context with the risk‐framed practices they are required to carry out.     

The Organization of Decision-making and the Dynamics of Policy Drift: A Canadian Health Sector Example

This historical‐institutionalist case study of public–private change in the rehabilitation health sector in Ontario, Canada, seeks to build on literature about the politics of policy drift, particularly with respect to health care systems. Rather than turning to higher‐order institutional factors, such as federalism and overall financing agreements between states and the medical profession, or to economic indicators such as change in expenditures, however, it posits that the particularities of how welfare‐policy sectors are organized with respect to their decision‐making contribute to drift. Such organization is framed by two factors. The first is the set of rules by which the public–private boundary is drawn, and the second is the structuring of public institutions that set legislation and regulation, and organize the policy networks attendant on them, around these boundaries. The degree of coordination or fragmentation among these, this case suggests, is a factor in the politics and dynamics of drift.     

Ideas and Social Policy: An Institutionalist Perspective

Since the beginning of the 1980s, historical institutionalism has emerged as one of the most influential theoretical perspectives in social policy studies. Although their work is insightful, most institutionalist scholars tend to relegate policy ideas to the back of their theoretical constructions dealing with welfare state development. The objective of this paper is to show how institutionalist scholarship can pay greater attention to ideational processes without abandoning its core assumptions about the structuring impact of political institutions and policy legacies on welfare state development. If institutions truly influence policy‐making, policy ideas matter in and beyond the agenda‐setting process. Related to existing policy legacies, perceived problems mesh with policy alternatives grounded in a specific paradigm. When stressing the need to reform, and promoting new alternatives, policy entrepreneurs draw on existing ideological repertoires to frame these alternatives. The ability to successfully frame policy alternatives can become a decisive aspect of the policy process. A discussion of recent European and North American policy debates illustrates these claims.     

Citizen participation: conflicting interests in state and national agency policy making

This study examines citizen participation in agency policy making across levels of governance in the United States, to address the following questions: Do citizens pursuing economic policy goals participate and wield influence in agency policy making differently than do citizens pursuing noneconomic policy goals? Does citizen participation in state policy making differ from that in national policy making? Analysis of policy making and participation in one policy sector, public forest management, suggests that citizens favoring economic (timber) goals participate more, and perceive greater influence, in state agency decisions, while those favoring noneconomic (environmental preservation) goals participate more, and perceive greater influence, in national agency decisions. These differences result from several factors, including legal constraints, agency composition, use outcomes, geographic location of stakeholders, and job mobility.     

Garbage‐can Policy‐making Meets Neo‐liberal Ideology: Twenty Five Years of Redundant Reform of the English National Health Service

The garbage‐can theory of decision‐making (Cohen et al. 1972), has been adapted into a perspective on policy‐making, with adaptations of the approach placing notable emphasis upon the health sector (Kingdon 2006; Paton 2006). This article creates an adapted ‘garbage‐can’ framework to help explain each stage of the reform of the English National Health Service (NHS) over the last 25 years. The emergence of the key idea and resultant policy at each stage of reform of the English NHS has been arational and indeed sometimes irrational. Policy has reflected advocacy by policy‐salesmen (Kingdon 2002), proffering ‘solutions’ to ill‐defined problems and answers to unasked questions, and politicians' short‐termist responses at each decision‐point. Yet the garbage‐can alone is not enough: if arationality rules in policy‐making day to day, this does not mean that there is not an overall ideological context, trend or bias in reform. The article also posits that ‘market reform’ has derived from the ideological hegemony of a naive anti‐statism (hostility to a misleadingly defined and often mythological ‘centralist state’) in public services and enthusiasm for market competition rather than any evidence‐based application of pro‐market ideas to health policy. A question arises: how are these two approaches (short‐term arationality and longer‐term ideological bias) combined in explanation of how policy over time is biased in a particular direction while seemingly arbitrary and directionless at each messy decision‐point. The article attempts to combine the insights of a garbage‐can approach with wider explanations of ideological hegemony.     

Well‐being of migrant and left‐behind children in China: Education,health, parenting,and personal values

Over the last several decades of urbanization and industrialization, China has encountered mass labor force migration from rural to urban areas. As a result, two‐child populations have dramatically increased in number: so‐called left‐behind children and migrant children. Using data from the 2006 and 2009 China Nutrition and Health Surveys, this study examined the effects of parental migration and residency status on the education, health, parenting, and personal values of children, with particular focus on left‐behind and migrant children. The findings suggest that parental migration and residency status play important roles in the educational and health outcomes, parental supervision, and personal values of children. Through analyzing the differences and possible reasons for disparate outcomes among child populations, this study aimed to improve public understanding of migrant and left‐behind children's well‐being in China, and explore implications for future studies and welfare policy making. Key Practitioner Message: ● Help to identify the impact of migration on individual, family, and the society domestically and internationally; ● Provide implications for welfare policy making, program design, and service delivery for migrant populations; ● Explore the approaches to addressing migration‐related issues in different countries with internal and transnational migrant populations.     

Collaborating with parents during intervention with parental agreement: Practitioner perspectives on procedural justice

With growing concerns about the efficacy and costs of intrusive child protection interventions and increasing recognition of citizen rights to participation in governance, jurisdictions are looking to collaborative alternatives that divert families from the courts and out‐of‐home care. In Queensland (Australia), “intervention with parental agreement” (IPA) is one such response. Under IPA, the statutory child protection authority can work collaboratively with families, without a court order, to respond to children assessed as “in need of protection.” In this paper, we use procedural justice theory as a lens to explore how IPA policy is enacted in practice. Procedural justice relates to the quality of treatment a person receives and the fairness of the process than an authority uses during decision‐making (Tyler, 2006 ). It is associated with voluntary cooperation and compliance; key practice concerns when working to address child maltreatment via parental agreement rather than court ordered intervention. We report on a qualitative study that utilized semistructured, in‐depth interviews to capture the perceptions of 30 practitioners regarding the factors that shape the extent to which they enact IPA policy in a procedurally fair manner. Strategies for enhancing procedurally just enactment of IPA policy in practice are discussed.     

Working late: policy relevance for older workers in the United States

The United States has seen a sizable increase in older worker labour force participation, although how much of this is due to public policy is uncertain. In fact, outside of academic and policy research circles, there has been relatively little attention paid to older workers and the challenges of an aging workforce in that country. Public policymakers have not demonstrated the same interest in expanding employment opportunities for older workers that they have shown for other groups, or that has been seen in other countries. Still, a number of significant pieces of legislation have been enacted over the past several decades that should be making continued employment at later ages easier, more attractive, or more essential financially. This paper examines those policies. However, because of confounding and conflicting influences from elsewhere, public policy initiatives focusing on older worker employment do not appear to be major contributors to rising labour force participation rates at older ages.     

Engaging men for gender justice: Overcoming barriers to girls' education in the Pashtun tribes of Pakistan

Resistance to girls' education is a social justice and human rights issue in many countries. In Pakistan, where the lowest school enrollment for girls is in Pashtun areas bordering Afghanistan, it is especially problematic. Pashtun society is patriarchal: Men have the power to construct obstacles to girls' education, and to remove them. This article therefore explores a different way of overcoming barriers to gender justice, namely through the participation of men. A qualitative Delphi process and in‐depth interviews with Pashtun men led to their consensus on seven key points of leverage where action could be taken. Participants agreed that progress toward gender parity could be achieved only by making allies of powerful community leaders, especially religious leaders, and by utilizing existing institutions, such as the mosque, Jirga (council of elders), and the men's guest house. For each point of leverage, a policy recommendation is made for increasing girls' participation in education.     

Crafting Child‐friendly Cities: Evidence from Biratnagar Sub‐metropolitan City,Eastern Nepal

Our cities are increasingly becoming the sites where children socialize, observe, and learn how society functions and many local and global activities have impacted children's health and well‐being. The Child‐friendly Cities initiative, launched by the United Nations Children's Fund and the United Nations Human Settlements Programme in 1996, draws in diverse stakeholders to place children at the center of the urban agenda. Based on social work research, this article analyzes the acclaimed status of Biratnagar Sub‐metropolitan city, Eastern Nepal, as a child‐friendly city. Despite its efforts, the city of Biratnagar is yet to meet the required criteria to claim itself as a child‐friendly city. Further improvements by the city administration in achieving children's participation in decision‐making, child‐friendly legal environment, and code of conduct are essential. Based on the evidence, the authors advocate for bottom‐up approaches that include children's voices and their real participation in city governance and a strong political will to craft child‐friendly cities, not as a policy rhetoric but for real. Enabling children to fulfill their potential as equal participants in crafting child‐friendly cities will require adults to relinquish some of their hegemonic powers of decision‐making on behalf of children.     

A Matter of Conscience? The Democratic Significance of 'Conscience Votes' in Legislating Bioethics in Australia

In Australia, members of a political party are expected to vote as a block on the instructions of their party. Occasionally a ‘conscience vote’ (or ‘free vote’) is allowed, which releases parliamentarians from the obligation to maintain party discipline and permits them to vote according to their ‘conscience.’ In recent years Australia has had a number of conscience votes in federal Parliament, many of which have focused on bioethical issues (e.g., euthanasia, abortion, RU486, and embryonic/stem cell research and cloning). This paper examines the use of conscience votes in six key case studies in these contested areas of policy‐making, with particular attention to their implications for promoting democratic values and the significance of women's Parliamentary participation.     

Governing Deviance in Public Space through Mayoral Orders: Fields Mismatch and Metropolitan Turbulence

This article addresses the issue of policy change and its consequences on the organizational field and institutional context, looking at the role of an instrument transfer process. We adopt a political sociology approach to policy instruments to account for the impact that the introduction of a securitarian instrument, the mayoral order, had on the implementation process of a social policy. Through a genealogy of the instrument we identify a constitutive, normative and cognitive dimension. Our aim is to explain the interaction between these institutional dimensions, the re‐definition of the organizational field of the policy, and the dynamics of metropolitan politics. Following a synthesis of the policy process and the institutional arrangements where the policy is implemented, we show how the instrument transfer triggered a division within the organizational field, and the rise of institutional tensions amongst local authorities. In the conclusion, we identify the institutional dimensions of the instruments and the policy implementation scale as elements that are to interact with public‐private relationships and institutional arrangements, and that have an impact on implementation process and policy outcome.