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.     

Do-It-Yourself Social Policy: Searching for a New Paradigm?

One of the most significant trends of recent decades has been the growing importance of do-it-yourself social policy: i.e. individuals constructing their own welfare mix both within the public sector and in private markets. This paper argues that this challenges the traditional top-down bias of social policy studies and requires a shift of focus within the discipline. The implications for normative theory, research strategy and policy analysis are explored. Some of the arguments for and against choice as a guiding principle are sketched out; some existing research on benefit take-up and choice in education and health is reviewed and the case for moving away from the economist's simple model of rationality is put forward. Finally, we argue, there should be more emphasis in social policy on developing a better understanding of the way in which individuals take their decisions, the context of public policy within which they act and the interaction between the two.     

Policy transfer,contagion effects and intra-party reform

ABSTRACT

This article examines the extent to which the Australian Labor Party (ALP) engaged in a process of policy transfer, learning from the UK Labour Party, when it reformed its federal leadership selection process in 2013. Bringing together insights from both the public policy and party organisations literature, the article develops an empirical framework for identifying instances of policy transfer (or contagion effects) that consists of three criteria: intention, motivation and implementation, which can examined through various types of empirical data (including interviews, documentary, and network analysis). Applying this framework to the ALP reforms, the article concludes that while it is possible to see evidence of a general shift to a similar, more inclusive selection process, policy transfer is more difficult to substantiate. There were clear differences in the specifics of how the process would work, and a temporal disjoint between when actors sought information about UK practices and when the reforms actually occurred.     

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.     

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.     

Root and Branch Restructuring to Achieve Major Cuts: The Social Policy Programme of the 2010 UK Coalition Government

The 2010 Coalition has set itself the challenge of combining an unprecedentedly rapid and profound retrenchment with a fundamental restructuring of the public sector, both to be accomplished within five years. The immediate justification is a presumed need to reduce national indebtedness. The longer‐term goal is to shrink the state, free up the market and set British political economy on a new course. The programme has encountered a number of set‐backs and some elements appear more likely to be realized than others. This article considers the objectives of the Coalition programme and the likely outcomes, using evidence from a number of sources including comparisons with the experience of retrenchment elsewhere and analysis of previous rounds of public spending cut‐backs.     

Social Policy: Now and Then

This article explores the way aspects of our approach to social policy in the UK have changed over the last 40 years – one academic lifetime and also, coincidentally, the lifetime of this journal – and the significance of six particular changes. More social problems have come to be seen as having a supra-national dimension: the scale and ramifications of problems are much better appreciated; the accepted territory of social policy has greatly widened; the state has lost people's confidence; we have come to see organizational and management issues as much more important; and the health of the economy has come to be regarded as a greater priority than the development of systems of social welfare.     

Assessing policy success and failure: targets,aims and processes

Assessing policy success and failure is a significant challenge. This article seeks to address this by utilizing two case studies of legislation from the United Kingdom Parliament, the National Minimum Wage Act 1998 and the Academies Act 2010, so as to develop a nuanced understanding of how and in what ways policies have been successful, or otherwise. Drawing on these two case studies, and the work of a variety of authors, the article illustrates the complex nature of the challenge, but suggests that by identifying “targets”, “aims” and “processes” it is possible to make reasonable judgements about the relative success of a policy. It concludes that this framework therefore has considerable potential utility.     

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.     

Fairness, Equality and Legitimacy: A Qualitative Comparative Study of Germany and the UK

The pressures of globalization and shifts towards post‐industrialism are producing policies that increasingly emphasize the common themes of activation and of individual responsibility for outcomes. Such approaches suggest normative principles of equality of opportunity rather than of outcome, and of individual rather than collective responsibility for the outcomes achieved. Does this imply a shift towards a common normative framework for European welfare states, with implications for future policy developments? This article reports a recent qualitative study examining ideas about fairness and social provision in the very different regimes of Germany and the UK. The analysis shows that while respondents in both countries value equality of opportunity as a normative principle, those in Germany are much more likely to argue that an equal opportunity approach requires government to guarantee equal access to basic services. They are also more likely to express concerns about market freedoms which allow those who can afford it better access to health care and education. Real differences in welfare values remain, loosely following differences of regime type, despite the greater emphasis on activation and individual responsibility across European welfare states.     

Independence, Risk and Compulsion: Conflicts In Mental Health Policy

During the second half of the 20th century the mental hospital population in England and Wales has fallen by some two-thirds. This dramatic shift in mental health policy has been based, in part, upon a policy assumption concerning the therapeutic benefits of hospital discharge for mental patients. This view derives from an acknowledgement of the potentially negative impact of institutional life and, conversely, a recognition of the beneficial effect of a return to independent living in the community. Yet, in recent years, concern has grown about the risks posed to the health and safety of patients and to the safety of other members of the community as a result of hospital discharge. In turn this has led to a policy shift in favour of increasing use of compulsory community powers. This article identifies the tensions in policy that exist between the goal of independence, the recognition of risk and the implementation of compulsory community powers, and seeks to provide an assessment of the extent to which they can be reconciled.     

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.     

Social Policy & Administration: Journal and Discipline

‘Social Policy & Administration’ is the oldest British social policy journal. This article charts its evolution over the last 40 years in the wider context of British social policy. It presents a timeline of the journal and discipline, an analysis of articles in the journal, and presents its most‐cited articles and most‐published authors. It uses this material to inform some impressions of the journal and discipline.     

What a Tangled Web We Weave: Ethical and Legal Implications of Deception in Recruitment

Deception in human subject research is neither uncommon nor prohibited. The use of deception in the recruitment phase of clinical research has received relatively little attention. Given that informed consent is foundational to human subject research, the practice of misrepresenting the study purpose in clinical research would seem to contradict one of the fundamental tenets of ethical human subjects research. Using the example of prodromal psychosis, this article the ethical and legal implications of deception in recruitment and the sufficiency of current guidance on the practice when the study involves a stigmatizing condition, the collection of genetic samples, or both. I conclude that when these two elements are present, deception should only be used when absolutely necessary and, if used, researchers should be required to debrief participants before the collection of genetic samples and give particular attention to minimizing risks of privacy breaches.     

Ethical consideration of the research proposal and the informed-consent process: An online survey of researchers and ethics committee members in Thailand

Researchers designing and conducting studies using human data should consider the values and principles of ethical conduct. Research ethics committees (RECs) typically evaluate the ethical acceptability of research proposals. Sometimes, differences arise between how researchers and RECs interpret ethical principles, and how they decide what constitutes ethical conduct. This study aimed to explore the opinions of these two groups about the importance of core ethical issues in the proposal and in the informed-consent process. An anonymous online questionnaire was distributed to a target population in health-related academic/research institutes across Thailand; 219 researchers and 72 REC members participated. Significantly, more REC members than researchers attributed the highest importance to three core ethical considerations – risk/benefit, vulnerability, and confidentiality/privacy. For the informed-consent process, significant differences were found for communication of risks, decision-making authority for consent, process for approaching study participants, and availability of a contact for study deviations/violations. The different ratings indicate differences in the groups’ perspectives on ethical principles, which may affect focal congruence on ethical issues in the proposal. Communication of these findings should help close gaps between REC and researcher perceptions. Further study should investigate how RECs and researchers perceive equivocal ethics terms.     

Adaptation to Labour Market Change in France and the UK: Convergent or Parallel Tracks?

France and the UK are markedly different welfare states, both in terms of regime type and in terms of the varying degree of state responsibility for reconciling work and family life. One recent theoretical strand suggests that welfare states will tend to grow more similar since they face broadly similar pressures. This paper discusses the policy responses in France and the UK to labour market pressures resulting from enhanced international competition, technological development and family change during the past decade. These responses are set in the context of European debates about the desirability of greater flexibility, up‐skilling and the activation of unemployed people, about the childcare needs of women workers and about the importance of paid work in reducing poverty and inequality. The analysis shows that trends to convergence are limited.     

Importing Workfare: Policy Transfer of Social and Labour Market Policies from the USA to Britain under New Labour

Britain's New Labour government has put welfare reform at the top of its political agenda. It has followed a radical “workfare” agenda in relation to labour and social market policies and no longer aims to secure full employment mainly through direct job creation or Keynesian demand management. Instead, it promotes equal opportunity for all based on a contract between benefits claimants and the employment service. The New Deal is at the heart of British activation programmes for the unemployed. American policy paradigms have influenced the design of the New Deal. Policy transfer in activation policies from the USA to Britain is due to institutional similarities in British and American welfare states on the one hand, and to the comparable structure of their labour markets on the other hand. The influence of the European social model on British labour market policies thus remains limited.     

In the Eye of the Storm: Civil Servants and Managers in the UK Department of Health

In the wake of the 2008 financial crisis, the UK government faces some tough choices over public expenditure, and these choices will have important implications for both the future of health policy and the way in which health services are managed. In this article, we examine the organization and leadership of the UK Department of Health and weigh its suitability to meet such challenges. We find an organization that is culturally split between public servants and managers, highly reliant on the ability of its key personnel to bridge these divides, and extremely responsive to the political goals of government ministers. We explore the modern DH using three types of evidence. First, the history of the department shows clear political efforts to reduce civil service discretion and focus the DH on the management of the English NHS. Second, the recent organizational structures of the DH show a bifurcation between policy direction and NHS management tasks. Third, an analysis of the top ranks of the department since 2005 shows the implementation of political preferences that are consistent with managerialism but inconsistent with the perceived characteristics of traditional civil servants. The result is a department which has changed just as frequently as the health service it oversees – a department which has been moulded by successive ministers into one for the management of the NHS. Our findings raise important questions about the value and purpose of long‐term organizational knowledge in policy formulation.     

Envisioning the Third Sector's Welfare Role: Critical Discourse Analysis of ‘Post‐Devolution’ Public Policy in the UK 1998–2012

Welfare state theory has struggled to come to terms with the role of the third sector. It has often categorized welfare states in terms of the pattern of interplay between state social policies and the structure of the labour market. Moreover, it has frequently offered an exclusive focus on state policy – thereby failing to substantially recognize the role of the formally organized third sector. This study offers a corrective view. Against the backdrop of the international shift to multi‐level governance, it analyses the policy discourse of third sector involvement in welfare governance following devolution in the UK. It reveals the changing and contrasting ways in which post‐devolution territorial politics envisions the sector's role as a welfare provider. The mixed methods analysis compares policy framing and the structural narratives associated with the development of the third sector across the four constituent polities of the UK since 1998. The findings reveal how devolution has introduced a new spatial policy dynamic. Whilst there are elements of continuity between polities – such as the increasing salience of the third sector in welfare provision – policy narratives also provide evidence of the territorialization of third sector policy. From a methodological standpoint, this underlines the distinctive and complementary role discourse‐based analysis can play in understanding contemporary patterns and processes shaping welfare governance.     

Recruitment and Retention in a Parenting Intervention: A Case Study with Parents Aging Out of the Child Welfare System

ABSTRACT

Parenting interventions are efficacious in reducing child maltreatment and negative child behaviors, yet the recruitment and retention of parents, especially vulnerable parents, in such interventions can be challenging. Prior research identifies several ways to improve recruitment and retention including laying the foundation for the intervention, fostering relationships with parents, ensuring fit of the intervention with the intended population, and identifying barriers to parents’ participation. This case study presents a process of recruiting and retaining a vulnerable group of parents, specifically parenting youth aging out of the child welfare system. In addition to outlining the strategies used, lessons learned are highlighted. Parents expressed interest in the parenting intervention, experienced significant needs, negotiated great instability in their lives, and valued the social connections facilitated by the group intervention. Despite the research team following best practices and investing significant time and resources, recruitment and retention remained challenging. Implications for future work in this area are presented.