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.     

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.     

抑制演化:库拉圈的社会权力

本文从迈克尔·曼“抑制演化”这一人类学命题入手,借用《老子》的某些思想与概念来解读人类学经典案例库拉。作者认为,曼由于材料不足而未能直接使用权力的四个来源解释新石器时代的“抑制演化”问题,而库拉民族志为探讨这一人类学命题提供了机会。《老子》的思想有助于我们较好地解释为何库拉宝物和名望都是“不积”的,为何库拉社会可以保持在“小邦寡民”的非文明状态。“不积”与“小邦寡民”使整个社会限制了四种社会权力的积累,有意保持在“抑制演化”的状态。以《老子》解读库拉,有可能为“抑制演化”这样的人类学经典理论提供一个独特的视角。     

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.     

Devolution and Centralism in the National Health Service

The reforms to the NHS following the White Paper, Working for Patients, were presented by the Conservative government as promoting devolution, defined as “decisions … taken at the lowest possible level” by Douglas Hurd (1991) — reflecting a senior Minister's interpretation of the overall policy agenda, including health. It was further claimed that such policies (“reforms in hospitals, in schools and in housing”) were a way to “empower citizens”. This approach was naturally an attempt to present the Conservatives' policy as pro-community and ‘practical’ rather than ‘ideological’ or free-market obsessed. It is worth renewing the debate about whether power and/or responsibility were devolved in the NHS — or, indeed, to the NHS from the Department of Health. Rudolf Klein, in the first edition of his The Politics of the National Health Service (1983), had no sooner pointed to the ‘devolution’ inherent in the 1982 reorganization of the NHS (based on the document Patients First (HMSO, 1981) when the Griffiths Inquiry recommendations were accepted. As a result, he was soon to observe that the pendulum — at that time — had quickly swung back to centralism, an observation reiterated after a few years when The Politics of the National Health Service came out in its second edition (Klein, 1989). In other words, there may be a cycle from centralism to devolution and back, or at least an interpretation of events as such in health policy, which makes a current reassessment timely. Which direction did the NHS Act of 1990 and related initiatives embody?     

Policy Style and Governing without Consensus: Devolution and Education Policy in Northern Ireland

Devolved government was established in Northern Ireland in 1999 at the same time as Scotland and Wales with a varying range of powers, particularly over the major areas of social policy including education. Devolution in Northern Ireland was set up on the basis of statutory power‐sharing in the core executive with a number of mechanisms to promote involvement by all sections of the community through their political representatives. This marked a departure from the traditional majoritarian and hierarchical model of UK government. The operation of devolved government in Northern Ireland requires a consensus on major policy items requiring legislation. The main aim of the article is to assess whether or not there is a devolved policy style in Northern Ireland and to compare this policy style with the findings of similar analysis in Scotland and Wales. Consideration is then given to the impact of both the distinctive policy processes which reflect the consociational nature of the Good Friday Agreement and wider social, political and administrative factors. Decision‐making on education policy is a totally devolved function and thus serves as an important example of autonomous policy formulation and policy‐making. The three main topics of current policy debate in education are selected for analysis to determine the nature of the decision‐making process and the existence of a distinct devolved policy style.     

Modernization and Devolution: Delivering Services for Older People in Rural Areas of England and Wales

The modernization of public services, with its emphasis on managerialism, choice, co‐production and outcome focused service delivery, has been implemented to a certain extent in both England and Wales. Indeed, the welfare states in both countries share a great deal, particularly in relation to policy objectives and the expectations of citizens. Devolution has chiefly meant that the instruments used to deliver policy have separated, although it remains unclear whether this amounts to formal divergence. What is also unclear is to what extent have the experiences of those living within the policy environment in both countries separated or diverged? This article addresses this question using qualitative data composed of interviews with policy actors in six rural areas of England and Wales. By focusing on the discourses of people involved in modernizing and providing services for older people in rural areas, we bring out the impact of modernization for older people. What we show is that modernization engages both service users and the wider population who may one day become service users. But the emphasis on these groups unfolds in different ways in England and Wales. In England, where there has been a commitment to a customer citizen, policy at the local level has emphasized re‐enablement, community development and individual responsibility. In Wales, where modernization has focused on collaboration and citizenship, local policies have focused on service users, and on engagement with the voluntary sector. In effect, the policy environment provides a different context for the experience of ageing in both countries.     

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.     

Stites Festschrift: An Introduction

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