New Models of Contracting in the Public Sector: A Review of Alliance Contracting,Prime Contracting and Outcome‐based Contracting Literature

The coordination of public services is an enduring challenge and an important policy priority. One way to achieve collaboration across organizational boundaries, which is being considered in public services such as the English National Health Service (NHS), is through the adoption of alliance contracting, prime provider contracting and outcome‐based contracting. This article reviews the cross‐sectoral literature concerning the characteristics of these new contractual models, how they function, their impact, and their relation to public sector governance objectives. These new contractual forms are characterized as models which, in line with the New Public Management (NPM)/post‐NPM agenda, seek to incentivize providers through the transfer of risk from the commissioners to the providers of services. Key findings are that the models are likely to incur high transaction costs relating to the negotiation and specification of outcomes and rely heavily on the relational aspects of contracting. There is also found to be a lack of convincing cross‐sectoral evidence of the impact of the models, particularly in relation to improving coordination across organizations. The article questions the reconciliation of the use of these new contractual models in settings such as the English NHS with the requirements of public sector governance for transparency and accountability. The models serve to highlight the problems inherent in the NPM/post‐NPM agenda of the transfer of risk away from commissioners of services in terms of transparency and accountability.     

Transferring HIV/AIDS Related Healthcare from Non‐governmental Organizations to the Public Healthcare System in South Africa: Opportunities and Challenges

Almost two decades after the transition to a post‐apartheid regime, South Africa is still high‐ranking in the incidence of chronic diseases like tuberculosis, HIV/AIDS, diabetes and hypertension. This article explores the transition from HIV/AIDS related healthcare offered by internationally supported non‐governmental organizations (NGOs) in rural areas to the inclusion of this healthcare into the public healthcare system. This transition is part of a wider process that represents the exact reverse of healthcare reforms in Western industrialized countries. Instead of a transition from public healthcare to privatized or marketized healthcare, the transition in South Africa is from partly private healthcare to a public healthcare system in which the private commercial health sector as well as all services provided by NGOs will be integrated. In that process, many obstacles obscure intended outcomes, such as equal access to healthcare. Some obstacles are evident in the case studies of two internationally supported NGOs in the field of HIV/AIDS healthcare. We will conclude that governance structures of public and private NGO‐based healthcare are often difficult to integrate; implementation timelines and priorities do not always coincide; and the public healthcare system is still too weak to deliver good quality healthcare in rural areas without continued NGO support.     

Voluntary Organizations as New Street‐level Bureaucrats: Frontline Struggles of Community Organizations against Bureaucratization in a South Korean Welfare‐to‐Work Partnership

In recent years, the role of voluntary organizations in welfare partnership has received considerable critical attention from scholars working in the field. While mainstream debates have valued state–voluntary sector partnership as participatory governance, critical studies have argued that it leads voluntary organizations to serve as a shadow state. The present study, however, contends that partnership does not necessarily entail participatory welfare or the complete subordination of the voluntary sector to the state's bureaucratic system. Rather, as new street‐level bureaucrats, voluntary organizations can exercise a degree of autonomy on the frontline despite the bureaucratic constraints engendered by partnership. Through an ethnographic analysis of Korean community organizations engaged as frontline agencies in a welfare‐to‐work partnership, this study unveils how the former have recreated democratic and inclusive environments in a particular policy setting by organizing non‐work activities and transferring administrative authority to recipients. Delineating such street‐level practices, this article demonstrates that state–voluntary sector partnerships may be sites of struggle where voluntary organizations continuously strive to actualize participatory governance in diverse and indirect ways.     

Civil society organizations and participatory local governance in Pakistan: An exploratory study

This paper analyses the extent to which the civil society organizations (CSOs) have influenced the decision‐making of the local government toward the needs and priorities of citizens. In development discourse, civil society organizations hold a significant importance as they are deemed to provide holistic and new ways to ensure participatory local governance. Therefore, their role against the backdrop of their involvement in mobilizing citizens’ involvement and influencing decision‐making in Pakistan calls for further research. This paper aims to fill this gap. Using qualitative research methods, the current paper appraises the role of CSOs in mobilizing public involvement in the decision‐making process of local government institutions of Punjab, Pakistan. The paper finds that the effectiveness of CSOs is very low due to various institutional and political constraints. Motivations for CSOs seeking citizen involvement have been instrumental in nature rather than motivated by participatory principles.     

天下为“公”：民国时期县级公产管理制度与产权变迁

近代公产转型与基层公共事业、国家治理机制的演变紧密关联，并承载了“公”观念的变迁。本文从产权视角出发，以民国时期浙江县级公产管理制度为基础，考察公产转型的历史进程。民国成立后，县级公产被纳入地方自治机构统一管理，其有别于“官产”“私产”的产权性质得到法律的确认与规范。在国家政策变动与治理事务扩张的背景下，自治机构对公产的管理引发诸多问题。20世纪30年代中期，南京国民政府推动县级行政制度改革，逐步将公产纳入政府管理，“公产”的概念也随之扩展，并逐渐向政府财产偏移。     

Involvement of Ministries of Health in Health Service Coverage Decisions: Is England an Aberrant Case?

This article examines the involvement of ministries of health in making health service coverage decisions in Denmark, England, France and Germany. The study aims to inform debate in England about the feasibility of reducing perceived ministerial and bureaucratic ‘interference’ in decisions affecting the National Health Service, based on interviews with senior government officials and other health system stakeholders. Ministries of health differ in their involvement in health system governance and coverage decisions (‘the benefits package’), reflecting differences in institutional arrangements. In all four countries, organizations at arm's length or independent from government are either involved in providing technical advice to the ministry of health or have been mandated to take these decisions themselves. However, ministries of health occasionally intervene in the decision‐making process or ignore the advice of these organizations. The Department of Health in England is not an aberrant case, at least in relation to coverage decisions. Indeed, ministries of health in Denmark and France play a larger role in making these decisions. Public pressure, often amplified by the media, is a shared reason for ministerial and ministry involvement in all four countries. This dynamic may thus limit the feasibility of attempts to further separate the NHS from both the Department of Health and wider political pressures.     

Developmental Social Policy,Social Welfare Services and the Non‐profit Sector in South Africa

The potential and challenge of constructing a democratic developmental welfare state through synergistic state‐civil society relations is the focus of this article. The author argues that while South Africa's pluralist approach, involving a leading role for the state in partnership with voluntary organizations, is a viable policy option to address the country's developmental challenges, anomalies between policy proclamations and actual practice raises questions about the efficacy of the partnership model and the gendered nature of welfare provision. Key governance issues and challenges, namely financial policies and institutional capability, underlie current failures in the delivery of welfare and care services, resulting in the non‐realization of these constitutionally guaranteed social rights. Further public action is needed to remedy the situation. Non‐profit organizations can advocate for policy reforms and challenge the instrumental nature of state‐civil relations and the abrogation of state responsibility for welfare services in contemporary South Africa.     

Promoting Healthy Routes Back to Work? Boundary Spanning Health Professionals and Employability Programmes in Great Britain

Between 2003 and 2011, the Pathways to Work (PtW) initiative was established across Great Britain, as policymakers sought to address the ‘health‐related, personal and external barriers’ faced by people who were out of work and claiming incapacity benefits (IBs). In the first 18 districts that PtW was rolled‐out, the Public Employment Service (Jobcentre Plus) and National Health Service (NHS) organizations worked in partnership to deliver ‘condition management programmes’, which helped IB claimants to cope with health problems. Evaluation research has identified significant health benefits associated with these condition management programmes, but there has been less discussion of the role of frontline NHS professionals in ensuring that services worked effectively on the ground. This article deploys the concept of ‘boundary spanning’ to explore the role of NHS professionals within PtW. Drawing on more than 50 in‐depth interviews, the article concludes that these NHS staff played a key boundary spanning role in facilitating partnerships, based on an ability to engage with the values/practices of other partner organizations (especially Jobcentre Plus) and a willingness to challenge established professional boundaries and ways of working. The article notes that recent policy initiatives have abandoned the PtW partnership approach in favour of more familiar models of contracting out, and that NHS professionals have been excluded from the delivery of health/employability services. It is argued that these recent changes may negatively affect the quality and range of health‐related services available to people on IBs.     

Making Markets in the English National Health Service

Many commentators point to the rise of markets in public services such as healthcare. However, the conventional ‘similarity’ thesis has been challenged by the ‘difference’ thesis. This article critiques and extends the analysis of a recent contribution by Jane Gingrich to the ‘difference thesis’ with a more detailed case study of the English National Health Service (NHS). It argues that the text tends to ignore earlier models and other associated variables; provides a rather crude monolithic characterization of ‘left’ and ‘right’; and assumes rather than demonstrates strategic choice. It modifies some of her major conclusions: markets in public services matter (correct); markets vary in profound and important ways (correct, but perhaps in other ways); and partisan politics are central to explaining and shaping markets (perhaps over‐stated). While Gingrich's ‘breadth’ account is persuasive at the macro‐level, some questions arise from a more detailed account of the English NHS. First, it is not certain that Gingrich's typology is based on the most important dimensions. Second, her account tends to under‐state the importance of issues such as the nature of contracts, price competition, regulation and policies such as Private Finance Initiative. Third, it is not clear that the Conservative healthcare market can be characterized as an Austerity Market, and the Labour market as a Consumer‐Controlled Market. Fourth, this static characterization under‐states the degree of change between and within governments. Lastly, it is not clear what type of market the coalition government has introduced, but this hybrid type may be marked more by policy learning than ideology.     

Local Participatory Democracy in Britain's Health Service: Innovation or Fragmentation of a Universal Citizenship?

A political emphasis upon the devolution of governance and management in the British National Health Service has, since 1997, been paralleled by an apparent concern to reinvigorate patient and public involvement in aspects of planning and decision‐making. A quasi‐communitarian rhetoric and echoes of nineteenth‐century welfare mutualism have accompanied significant reform of arrangements for patient and public involvement. This article considers the degree to which this fusion of normative exhortation and structural reform heralds a marked evolution in the principles and practice of participatory democracy in the planning and governance of health care. The reforms, in historical perspective, appear to constitute a significant extension of the arenas within which citizens can explore and debate issues pertaining to the health service. But selective political recourse to quasi‐communitarian sentiment points to an embryonic policy discourse that links entitlements to obligations on the part of those reliant on the NHS. This may be of considerable significance in a system of health care to which entitlement has, historically, been cast as a right of citizenship.     

Governance and Participation in Local Welfare: The Case of the Italian Piani di Zona

This article analyses four cases of governance in Italian local welfare systems. Following Law 328/2000, the design and management of the social services system in Italy involve different public responsibility levels, mainly regional and municipal. In order to manage social policies, Italian municipalities have to join in new inter‐municipal groupings called ‘Piani di Zona’ (Area Plans). Moreover, the law provides for engaging in these Plans even local third‐sector organizations and citizens. The article attempts to highlight the implications of this complex system that is leading local authorities to open new governance arenas. We hereby present the results of a research project on two Piani di Zona in the Region of Lombardy (Northern Italy) and on two in the Region of Campania (Southern Italy), carried out by means of institutional analysis. We particularly focus on the dynamics of participation triggered by the Piani di Zona. Our hypothesis is that the role of public administration is a fundamental variable to understand the different ways of participating. In this sense, we discuss the dynamics of local governance by relaying them to four main questions: who participates in what, where and how?     

‘Creating NHS Local’: The Relationship between English Local Government and the National Health Service

Following recent reforms of both local government and the National Health Service, there is significant emphasis in both services on improving inter‐agency collaboration, user involvement and strategic commissioning. In response, this article reviews historical debates about the relationship between local government and health care, before arguing that these two ‘partners’ need each other now more than ever. If local government is to be a ‘place‐shaper’, then it needs significant influence over local health services, while the NHS needs to learn from the best of local government if it is to gain sufficient local legitimacy to take the difficult decisions it needs to take. Against this background, the article reviews different options for future joint working, exploring various options for enacting a new relationship between local government and the NHS.     

Legal Mechanisms for the Joint Governance of Public and Private Rights

Traditional jurisprudence has produced few studies at the level of institutional operation, resulting in a lack of knowledge about the structure, actors and symbols involved in the modernization of social governance. This is so much so that modernization of social governance is in practice misunderstood as the rule of law, informatization and adoption of technology. The core issue of social governance is the division of oversight and penalty costs between the state and individuals, but we need to call upon a statutory platform to facilitate cooperation between public and private rights. The modernization of social governance involves the use of legislation to provide techniques and statutory platforms for cooperation in an open society, ensuring the reasonable division of social governance information and penalty costs when public and private rights overlap. The social governance techniques that enable public and private rights to work together involve taking a group of observable symbols or organizations on which consensus has been reached as a statutory platform, with all sides bringing greater accountability to bear on this platform in order to maximize their interests and minimize their transaction costs, with no need to inquire further into its particular constitution.     

过渡治理情境下的中国社会服务困境:基于Z市社会工作服务的研究

社会工作近十年来在创新社会治理的推动下发展迅速。本文将重点关注于社会服务组织的服务供给过程及其导致的社会服务困境。通过对治理情境的拓展分析,引入过渡治理情境概念,分析我国社会服务供给。在此情境下,本文以Z市家庭综合服务中心为例,围绕自由裁量权这一概念讨论社会服务组织的服务供给策略及其所导致的服务困境。在过渡治理情境中,消极的自由裁量权与社会工作的半专业化发展结合在一起,社会服务组织选择了“活动化”和“指标化”的服务供给,令社会服务处于创新和碎片化之间,而导致社会服务陷入困境。社会服务困境根源的解决在于建立合作的治理情境、强化本土化社工专业力量以及充分发挥第三方的社会服务供给效力。     

Informing UK Policy Development on the Regulation of CAM Practitioners: Lessons from Hong Kong?

Public policy discussions on how to regulate acupuncture and herbal medical practitioners have reached a stalemate in the United Kingdom. After considerable activity in the first half of the current decade a wider review of professional regulation has re-opened the discussion as to the most appropriate way to regulate the practice of all health-care practitioners. In the meantime, the public continues to consult complementary and alternative medicine (CAM) practitioners in large numbers and self-medicate with herbal products and other natural remedies, posing challenges for policy-makers as to how to ensure public safety. In the NHS, providers and purchasers struggle to reconcile demands for access to CAM services with their clinical governance requirements. Hong Kong implemented new arrangements for the statutory regulation of traditional Chinese medical practitioners in the 1990s and has experienced the challenges of regulating a large established private market as well as integrating Chinese medicine further into the public health system. This experience is analysed in order to see whether the approach adopted there could address the public policy challenges faced in the UK. The article finds that, despite key cultural and historical differences related to the provision and use of CAM services, the similarities between the health-care systems and the reasons for moves to professional regulation in Hong Kong and the UK provide useful insights into what is happening in the UK in relation to service provision and the relationship with the NHS and the medical profession. These are discussed in the light of current health policy developments in the UK.     

乡镇政府在农村公共服务中的角色定位与功能实现

乡镇政府是农村社会的＂法人行动者＂,尽管它的组织形式一度为人民公社,其职能也曾表现为政治统治型和经济发展型,但它始终在农村公共服务与管理中扮演着重要角色。乡镇政府是新农村建设和城乡公共服务一体化的重要组织者,应该凸显公共服务型和治理型的功能。如此,为实现其与角色对称的功能,乡镇政府可以通过明确重点服务域、确立决策权威、增加服务资金投入等践行农村公共服务的供给与管理功能。     

From Official Supervision to Self‐monitoring: Privatizing Supervision of Private Social Care Services in Finland

In October 2011, a new Act on Private Social Care Services came into force in Finland. The Act included a provision on a ‘self‐monitoring plan’. According to the provision, providers of private social care services are required to draw up a self‐monitoring plan and to follow its realization. The plan must be kept publicly on view so that clients and their relatives can also keep an eye on the realization of self‐monitoring. In this article, self‐monitoring is first explained and then briefly analyzed against the background of a wider theoretical discussion on accountability. It is argued that the introduction of client involvement in the supervision of private social care services represents a new mechanism of accountability that is typical of the Post‐Keynesian welfare state. Because public authorities are no longer able to supervise the growing number of private social care service providers, the responsibility has been partly shifted to service providers themselves as well as to clients. However, it is argued that the idea of self‐monitoring lends itself poorly to ‘delegated’ private social care services, i.e. to services that are outsourced to private service suppliers. Supervision of private social care service providers should not be too eagerly delegated to service providers themselves, or to clients, because we are here dealing with the constitutional right to adequate social care services. Client involvement also involves numerous practical problems, as shown at the end of the article.     

Human Motivation and Professional Practice: of Knights, Knaves and Social Workers

Efforts to improve the efficiency and responsiveness of public services by harnessing the self‐interest of professionals in state agencies have been widely debated in the recent literature on welfare state reform. In the context of social services, one way in which British policy‐makers have sought to effect such changes has been through the “new community care” of the 1990 NHS and Community Care Act. Key to this is the concept of care management, in which the identification of needs and the provision of services are separated, purportedly with a view to improving advocacy, choice and quality for service users. This paper uses data from a wide‐ranging qualitative study of access to social care for older people to examine the success of the policy in these terms, with specific reference to its attempts to harness the rational self‐interest of professionals. While care management removes one potential conflict of interests by separating commissioning and provision, the responsibility of social care professionals to comply with organizational priorities conflicts with their role of advocacy for their clients, a tension rendered all the more problematic by the perceived inadequacy of funding. Moreover, the bureaucracy of the care management process itself further negates the approach's supposedly client‐centred ethos.     

Support for Carers of Older People: The Roles of the Public and Voluntary Sectors in Sweden

This study examines the support services offered to informal caregivers, whether directly or indirectly, in Sweden over the period of a special investment initiative between 1999 and 2001. Data were collected in a Swedish county using two separate mail questionnaires in 1999 and 2001. The first questionnaire was addressed to each municipality in the region. The second questionnaire was sent to a random sample of voluntary organizations in the area. The findings showed that only the municipalities provided direct forms of relief service, day care and financial support. The voluntary organizations’ support for carers focused on support groups and training as well as services for older care users themselves. There was a significant increase between 1999 and 2001 in the number of municipalities providing information material and training for carers and using professional caregiver consultants. On the one hand, the Swedish public social care system appears to be following the international pattern in paying more attention to informal caregivers and investing in support services for them. On the other hand the findings did not show any growth in support provided by the voluntary organizations. Here Swedish welfare is dissimilar to other European countries, where it is increasingly common for voluntary organizations to play an important role as providers of support for carers.     

技术治理的悖论:一项民意调查的政治过程及其结果

技术治理的逻辑是通过识别和处理源源不断的问题进而把社会呈现在国家面前。它能够完成其使命吗？本文以S市C街道2014年至2016年的连续民意调查为经验对象,系统阐述民意调查为何表面上是一个统计学过程,实质却是由权力运行支配的政治过程。分析表明,在将复杂民意化简成民调数据时,技术只能保证化简程序的严谨性,化简方向则由操作者决定。民调项目的规定性源自基层权力结构,又被转移到对复杂民意的筛选、压缩和量化过程之中,生成指标体系。据此,本文揭示了技术治理的悖论--国家通过技术之眼观察社会时,看到的可能是自己的影子。