New Policy Spaces: The Impact of Devolution on Third Sector Policy in the UK

The development of third sector policy in the UK since 1997 has seen changes which have been of significance both for analysts and practitioners. This period has seen government engagement with and support for the sector extend far beyond the levels found throughout much of the last century. This has led to a growth in the size and scale of the sector and a closer involvement of sector representatives in political debate and policy planning. These changes have taken place at the same time as third sector policy has been devolved to the new administrations in Scotland, Wales and Northern Ireland. This article explores the impact of devolution on these policy developments and assesses the extent to which political devolution has led to policy divergence across the four countries in the UK. The conclusion is reached that policy devolution has created important new space for policy development for the third sector across the UK, but that the direction of travel in all four regimes has remained remarkably similar.     

Devolution and Patient Choice: Policy Rhetoric versus Experience in Practice

Background: market reforms in England have been identified as making a clear distinction between English health policy and health policy in the devolved systems in Northern Ireland, Scotland and Wales. Patient choice is a high profile policy in the English National Health Service that constitutes significant changes to the demand side of health care. It is not clear what national differences this has led to regarding implementation of policy. This article presents the findings from a large UK‐wide study on the development and implementation of policies related to patient choice of provider. The findings reported here relate specifically to the policy development and organizational implementation of choice in order to examine the impact of devolution on health care policy. Aim: this study examines patient choice of provider across all four countries of the UK to understand the effect of differences in national policies on the organization and service how choice of provider presented to patients. Methods: at the macro‐level, we interviewed policymakers and examined policy and guidance documents to analyze the provenance and determinants of national policy in each UK nation. At the Primary Care Trust or Health Board level, we interviewed a range of public and private health service providers to identify the range of referral pathways and where and when choices might be made. Finally, we interviewed ear, nose and throat, and orthopaedics patients to understand how such choices were experienced. Findings: while we found that distinct rhetorical differences were identifiable at a national policy level, these were less visible at the level of service organization and the way choices were provided to patients. Conclusion: historical similarities in both the structure and operation of health care, coupled with common operational objectives around efficient resource use and waiting times, mediate how strategic policy is implemented and experienced in the devolved nations of the UK.     

Beyond Rhetorical Differences: A Cohesive Account of Post‐devolution Developments in UK Health Policy

Health is perhaps the most significant policy area to be devolved to decision‐makers in Northern Ireland, Scotland and Wales. Consequently, there has been a great deal of interest in assessing the extent to which health policies (which already differed somewhat prior to devolution) have diverged since 1999. To date, analyses have tended to focus either on health care policies or on specific public health issues (e.g. health inequalities or tobacco control). The story that emerges from this body of work suggests health care policies have diverged significantly, whilst public health policies have remained remarkably similar. This article is one of the first to consider health care and public health policy alongside each other. It reassesses and updates previous analyses, incorporating developments relating to the 2010 general election and the 2007 and 2011 devolved administration elections. Drawing on a variety of textual sources (policy documents, research evidence and corporate literature), our findings differ from existing analyses in suggesting that, despite some noticeable differences in policy rhetoric, approaches to both health care provision and tackling public health problems remain similar. Looking to the future, the article concludes that the common economic challenges, combined with a tight fiscal policy (that remains excepted from devolution), means the similarities in health care provision across the UK are likely to remain more pronounced than the differences. However, current debate about the constitutional settlement, and in particular the prospect of greater fiscal freedoms for the devolved administrations, may provide opportunities for more meaningful divergence in health policy than has been possible hitherto.     

Devolution in a ‘Stateless Nation’: Nation‐building and Social Policy in Scotland

The implications of the 2011 Scottish election and the proposed referendum on Scottish independence for the future of social policy across the devolved UK are profound but far from certain. It is crucial to understand not only the historical nature of this conjuncture but to develop an adequate conceptual understanding of the place of social policy in the dialectic between state and nation in Scotland. To this end, we critically examine theories that depict Scotland as an essentially ‘stateless nation’ in the light of recent developments. In so doing, we examine the implications for social policy of the changing character of statehood in Scotland, the nature of civil nationalism, and the problem of legitimacy in Scotland for the UK as a multinational state. As the architecture of statehood is re‐negotiated, strong centrifugal pressures are being created for a more distinct divergence of social policy in Scotland from the rest of the UK regardless of the outcome of the independence referendum. Policy‐making is ensnared in a series of tensions, not just between Westminster and Holyrood but also, more broadly, tensions between competing principles of social justice and territorial justice, and competing demands between welfare nationalism and competitive nationalism.     

The definition of social work in the United Kingdom, 2000–2010

Dickens J. The definition of social work in the United Kingdom, 2000–2010. This article reviews the approaches that the four countries of the United Kingdom – England, Scotland, Wales and Northern Ireland – have taken in recent years for organising, regulating and defining social work. Social work is one of the policy areas that have been devolved to the constituent countries. This has brought extensive organisational changes, multiple policy initiatives and a proliferation of regulatory and advisory agencies. The article focuses on the attempts by these official bodies to define social work, treating the United Kingdom as a case study of the tensions of specifying what social work is and what it should be. The various attempts expose the strains and overlaps between the different agencies, and a bigger struggle to contain and control social work. The article highlights four key dimensions in the enduring debates: values–roles, social–individual, care–control and public–professional.     

Direct Payments and Disabled People in the UK: Supply, Demand and Devolution

Direct payments have brought new opportunities for self-determinationand independent living to disabled people in the UK, featuringprominently in government strategy and the 2006 White Paper,‘Our Health, Our Care, Our Say’. However, ten yearsafter direct payments legislation, take-up remains low and implementationvaries greatly. Rates of take-up in England remain more thandouble those in other parts of the UK, raising questions aboutdevolution and equity. This paper presents data from a nationalstudy to examine some of the mechanisms underlying uneven outcomesfor disabled people in different parts of the United Kingdom,with particular reference to the politics of devolved governance.The analysis focuses on scope for interpretations of policy;resources for information and training; the impact of mandatoryduties and targets; extensions to new user groups; and the roleof support organizations and disability activism. The evidencesuggests that local variations have been produced not only by‘local’ factors, but also by different opportunitystructures for policy development in England, Scotland, Walesand Northern Ireland. This raises questions about the impactof devolution on equity and opportunity for disabled peoplein the UK.     

Health Policy and the Politics of Evidence

National decisions on the drugs, treatments and medical devices that should be funded through public expenditure are a fundamental element of health policy. But despite a political emphasis upon evidence‐based policy, the results of rigorous clinical trials and statistical modelling techniques rarely speak for themselves. So, does the pre‐eminence traditionally accorded to quantitative data in the medical field underpin policy decisions on a consistent basis? Or are more subtle, less transparent characteristics of context and interaction evident in the shaping of attendant decisions? This article considers these questions by drawing on a study of decision‐making in the National Institute for Health and Clinical Excellence (NICE)—an organization established by the British government in 1999 to decide whether selected health technologies should be made available throughout the National Health Service in England and Wales. In broad terms, the findings point to the primacy of arguments based on quantitatively oriented, experimentally derived data but also to a discursive hegemony of clinicians and health economists in mediating, including or debarring more qualitative, experientially based evidence. A more complex, dynamic understanding of policy governance in the field of health technology appraisal—founded on a discursive appropriation of the idea of the “common good”—goes some way to explaining the persistence of this hegemony despite an avowedly inclusive, plural approach to decision‐making.     

Challenging scalar fallacy in state-wide welfare studies: A UK sub-state comparison of civil society approaches to addressing youth unemployment

Here we make an original, empirical contribution to debates on welfare pluralism, the mixed economies of welfare and territorial rescaling by comparing civil society approaches to tackling youth unemployment in England, Scotland and Wales. Our core finding is that academic and policy literature's frequent characterisation of the UK as a single Liberal welfare regime is based on methodological nationalism privileging state-wide analyses. In short, a scalar fallacy pervasive in international welfare studies. In the context of the global rise of meso-government and so-called ‘stateless nations’ pressing for greater autonomy, our case-study challenges the dominant paradigm. Our analysis shows the liberal characteristics of work-first policy orientation and marketised civil society are concentrated in England then tempered by devolved (social) policy. Based on contrasting, left-of-centre and civic nationalist governing traditions, grounded in multi-level electoral politics, we show the devolved nations taking a different approach to Westminster, partially eschewing the market and incorporating collectivism and co-production.     

Mental Health Policy in Northern Ireland

Mental health policy in Northern Ireland has moved through a number of phases during the past seventy years. This article examines some of the developments during each of these phases in the context of political factors which had an effect on policy formation and implementation. The services which existed in 1921 were deeply rooted in the lunacy legislation and provision of nineteenth century Ireland. The political uncertainty and financial stringency, which characterized the following two decades, resulted in a situation of almost complete stagnation in those services. The contribution of Northern Ireland during the Second World War guaranteed a financial commitment by Britain to the building of a comprehensive health service in the post-war era. The expansion in mental health services was unprecedented. The relative stability of this era was shattered by the political “troubles” of the 1970s and the imposition of “direct rule” from Westminster. Though advantageous to health service development at first, this has now led to tighter central controls and the further loss of local autonomy. In policies dictated from Westminster, Area Boards moved towards a reduction in psychiatric beds to 1,500—the level of provision in 1870. History tells us that the needs of mentally ill people have not had a significant impact on services in the past. Will the future be any different?     

Policy Changes in Community Mental Health: Interventions and Strategies Used in Sweden over 20 Years

The deinstitutionalization of mental health care has changed the responsibilities of involved authorities and has led to a continuous need for new treatment forms and interventions. This article describes this development in Europe, and in particular how these new conditions have been handled in Sweden over the past 20 years at the level of governmental policy‐making. Three major policy documents from 1994, 2009 and 2012 were included in this study. To increase our understanding of the policies' contents, we have used theoretical concepts concerning governance, implementation and political risk management. Although our main interest was to find out how the government handles interventions for users of the mental health care system, we found that the policy work is progressing stepwise. The first document, from the deinstitutionalization era, did not discuss interventions clearly. Instead, it was mainly concerned with both practical and economical areas of responsibility. The second document, from the post‐deinstitutionalization era, was more focused on what services should be delivered to the users, while the most recently published document to a greater extent addressed the question of how the support is supposed to be designed. The trend in European community mental health policy has been to advocate services in open forms that are integrated into the society's other care systems. This is also the case in Sweden, and continuous work is being done by the government to find strategies to support the development, and to meet the needs at both political and local levels.     

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.     

Understanding Policy Reform in Colorado's Domestic Violence Offender Treatment Standards

This study examines the perceived conditions leading to Colorado adopting revised Standards for treating domestic violence offenders from the perspective of Kingdon's multiple streams theory. A within‐case analysis of ten semi‐structured interviews explores the Domestic Violence Offender Management Board in Colorado's process for revising Colorado's 2001 Treatment Standards. Findings suggest a benign political stream, supported by technically feasible and value‐accepted policy ideas, feedback and indicators of the problem, promoted a favourable setting for change. At least two policy entrepreneurs championed the decision‐making process. Agenda setting and policy formulation depended on three elements: feedback from existing programmes, indicators of continued difficulty in effectively treating offenders, and the existence of a suitable policy alternative. This study contributes a rare application of multiple streams theory to a criminal justice context in a sub‐national government. Future research should explore whether the presence of a benign political stream influences the development and revision of domestic violence policy in other policy environments.     

Is There an Indian Policy Process? An Investigation into Two Social Policy Processes

India is a huge, poor, fast developing, centralized and increasingly unequal, democratic country. The core argument of this article is that these and other contextual factors have an impact on the way in which social policies are formulated and implemented. The focus of the article is on two such policies on food and primary education. Based on secondary material and own fieldwork, the shaping of these two policies is discussed and some major characteristics of the two social policy processes are highlighted. This analysis brings to light the existence of two paradoxes present in social policy processes in India: one related to the fact that social policies are important for regime legitimacy but nevertheless suffer from a lack of political commitment; the other related to the fact that centralized decision‐making goes together with the widespread involvement of local politicians in policy implementation. These two paradoxes, the article concludes, are the result of the wider context in which social policies are shaped and are hence not easily resolved.     

Alcohol Policy and Health Promotion: Rhetoric and Reality

This paper examines the economic and political constraints on the development of Australian policy directed at the prevention of alcohol-related health problems. An analysis is made of recent official statements and enquiries and it is argued that heightened concern about prevention arose in the context of budgetary problems and the need for governments to find ways of containing expenditure in the welfare area. The effectiveness of current efforts is called into question by the real nature of the constraints on health, and of the disparity between prevention rhetoric and policy implementation. It is suggested that government statements of intent to reduce the overall level of alcohol comsumption in the community entail no clear-cut commitment to a particular strategy or set of strategies, and that recent government actions indicate the limited possibilities for the implementation of such a policy. Any policies governments are likely to pursue are unlikely to disrupt major sources of government revenue. Because of the high profile that governments have created for the problem, there is the possibility that the policies that are adopted will be politically expedient in the short-term rather than providing real solutions.     

Presidential Direct Action and Policy Continuity: The Case of U.S. International Population Policy*

Objectives. The purpose of this study is to describe and analyze the modern practice of unilateral presidential policy making in the area of U.S. international population policy. The analysis focuses on the implications of this practice in a constitutional system intended to limit and constrain direct presidential action in policy making. Methods. The authors conduct their analysis using a variety of qualitative sources, including leading studies on the topics of presidential direct action and U.S. international population policy, and government documents. Conclusions. Policy development in this area has been marked by dramatic back‐and‐forth shifts due to the modern practice of presidents making many decisions without legislative involvement. Although not the only policy area in which this practice has become the norm, the case study of U.S. international population policy reveals the pitfalls of deviating from the constitutional design of a system of balanced and constrained powers.     

The Reformed National Health Service: A Commentary

This article presents an overview of the current state of the reforms of the British NHS instigated by the NHS and Community Care Act (1990) following the White Paper Working for Patients (1989) and introduced in England and Wales in 1991 and in Scotland and Northern Ireland in 1992. The reforms were not only wide ranging—affecting virtually all aspects of health care organization and delivery—but also ongoing. Moreover, there has been little systematic evaluation of the impact of the reforms. While making reference to other aspects of the reforms this survey article concentrates on two important issues of central concern to the NHS—efficiency and equity—and highlights some of the associated research and literature.     

Agenda Setting and State Policy Diffusion: The Effects of Media Attention,State Court Decisions,and Policy Learning on Fetal Killing Policy*

Objectives. This study combines theories on agenda setting, policy innovation, and policy learning to develop an improved model of state policy change. The case of fetal killing policy change in the states is used to develop a model that incorporates national media attention and the decisions of state courts, in addition to policy learning variables that account for the policy changes of neighboring states and the passage of time. Methods. I test the effect of national media attention, decisions by the courts, and the actions of neighboring states on the likelihood that states will change their fetal homicide policies. Using time‐series cross‐sectional data from 1970 to 2002, the model is tested using logistic regression analysis. In addition to testing the theories mentioned above, control variables in the model include citizen and government ideology and the percentage of state residents who are fundamentalist Protestants. Results. Three of the four research hypotheses are supported by the statistical analysis. The results demonstrate that increased media attention to fetal homicide in a given year increases the likelihood that a state will change its policy the next year. Support is also found for the hypothesis that state court decisions will affect policy change. One of the control variables, government liberalism, is also found to decrease the likelihood that states will change their fetal homicide policies. Conclusions. This study lends insight into why states change their policies by including agenda‐setting variables such as media attention and decisions made by the courts. States do react to the actions of the courts by making changes to policies affected by the decisions.     

The 1996 Research Assessment Exercise and the Response of Social Work Academics

Summary In 1996 the Higher Education Funding Council undertook the fourthResearch Assessment Exercise (RAE) in universities in England,Wales, Scotland and Northern Ireland. Performance in researchis a crucial measure in university departments because it hasdirect implications for funding, but some doubt that the criteriaused are appropriate measures of quality of research. Many factorshave an impact on the way that research by social work academicsis presented in the RAE. After the 1996 RAE, the Joint UniversityCouncil Social Work Education Committee undertook a survey ofdepartments which teach social work to try and elicit responsesto the assessment exercise which might inform preparations forthe next RAE.     

Social Work, Sectarianism and Anti-sectarian Practice in Northern Ireland

Correspondence to Dr Jim Campbell, Department of Social Work, The Queen's University of Belfast, 7 Lennoxvale, Belfast BT9 5BY, Northern Ireland. Jim Campbell lectures in the Department of Social Work, The Queen's University of Belfast. His doctoral thesis was on the concept of violence in social and political thought. His current research interests include social policy in Northern Ireland and mental health social work Summary This paper addresses a subject relatively unknown to the Britishand international social work audience—that of trainingfor anti-sectarian practice. In doing so, it points to someof the complex, even dangerous issues raised by such trainingfor social work students and practitioners in Northern Ireland.The paper comments upon the limited but significant ways inwhich social work educators and practitioners have tried tochallenge sectarian discrimination in Northern Ireland, andproposes methods in train ing and research which might facilitatea better understanding of these processes.     

Being counted? Examining the prevalence of looked‐after disabled children and young people across the UK

Since the 1970s, there has been growing academic interest in children and young people living in state care and, more recently, in the lives of disabled children. However, there has been little attention on the lives of disabled children who are looked after by the state. This paper compares and critiques what is known about the numbers of disabled children who are looked after in England, Northern Ireland, Scotland and Wales. We discuss the conceptual and methodological limitations of systematically collecting data on disabled children in state care across the UK. We argue that to ensure that the rights of disabled children in state care are identified, acknowledged and upheld, ‘being counted’ is a fundamental first step.