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?     

The Achilles' heel of scale service design in social security administration: The case of the United Kingdom's Universal Credit

This article takes a critical view of the United Kingdom government's design for the delivery of the Universal Credit (UC) benefit reforms. It is argued that the UC is destined to fail because of the policy's extension into specifying the means (“digital by default”) of delivery for such services. The authors argue that an unseen but ubiquitous set of “scale” management assumptions has been allowed to infiltrate the means by which the government intends to enact its headline policy objective to “make work pay”. Following Seddon's “Vanguard Method”, a practical example of how a better service was designed in a local authority housing benefits service is then examined. Results from this service include being able to deal with up to 50 per cent more demand, with fewer resources, in half the official target time. Finally, the article will conclude with a call for more evidence‐based policy.     

Revisiting demand,politicization and externalization in authoritarian political regimes: policy advisory system in Russian practices

ABSTRACT

This study contributes to debate on three related questions in Policy Advisory System research. Is the Policy Advisory System concept applicable in countries other than developed democracies? How does it function in a state-centred authoritarian regime? How does the authoritarian environment affect tendencies such as “politicization” and “externalization”? These questions are addressed using materials on the current Russian governance structure and advisory practices, focusing on two broadly defined “governance subsystems” in the Presidential Administration of Russia, “Political Bloc” and “Economic Bloc”, both acting as regular customers for advisory communities. One finding is the phenomenon of “Dual Demand” from the same centre of power—“stability” for “Political Bloc” and “innovation” for “Economic Bloc”—which contributed to creation of two different clusters of policy advisory agencies with different statuses. Other findings include transformation of “politicization” to policy control mechanisms and attempted “externalization” turning into the reverse—“internalization”—bringing independent advisory organizations under the supervision of government structures.     

New Labour, Work and the Family

New Labour has put support for the family at the core of its notion of the “strong community”. Across a range of policy areas the Labour government can be seen to be developing a direct and explicit family policy. But what kind of community is the government trying to shape by these policies? On the one hand, Labour appears to support the family as the basis of a more moral, dutiful and cohesive community. On the other hand, the government has given weight to policies that support social inclusion in the community through paid work. This paper examines whether there is a tension in Labour’s social policies between its emphasis on the importance of stable family life and the primacy given to paid work. Are critics like Ruth Levitas right when they argue that the government’s emphasis on paid work devalues, and is unsupportive of, unpaid work, especially caring for children and other family members? Alternatively, can this combination of communitarianisms—community as “stable family” and community as “paid work”—be seen to be marking out some “third way” on the family? We shall show that different aspects of the government’s family policies reflect different perspectives and policy agendas within New Labour and third‐way thinking more broadly. And while recognizing the tensions between work and the family, we shall suggest that they are often overstated and fail to give sufficient weight to the complementary aspects of Labour’s welfare reforms.     

Social Justice and the Reform of Social Security

There have been massive increases over the years in expenditure on the public services loosely grouped together as the “welfare state”, but widespread dissatisfaction persists. This article is a critique of the proposals for reform presented in the Report of the Commission on Social Justice, set up by the late John Smith. The report contains a sweeping condemnation of existing arrangements and puts forward a series of recommendations ranging from the health service to decentralization in government and from employment policy to benefits for the elderly. As was perhaps inevitable, some are more precisely presented than others. An important example of the more fully specified proposals is one to establish what would, in effect, be a means-tested “pension guarantee”but with “means”so defined as to exclude capital and with much improved “disregards”. Another is the endorsement of the proposals to extend social insurance to part-time workers—a proposal which raises some controversial issues. There is much in this report that deserves close attention, and it is, therefore, all the more unfortunate that its proposals are not presented in the form of a quantified plan for social policy. Even for the first five years or so of the fifteen the Commission has in mind, there is no attempt at quantification. The importance of economic growth is rightly stressed, but “faster growth”can become a panacea that obscures the need for choice, not only between private and public expenditure but also between the various components of public policy itself.     

Housing and Accommodation of Irish Travellers: From Assimilationism to Multiculturalism and Back Again

This article charts the changing conceptualization of Travellers in relevant Irish central government policy statements since the 1960s, together with the accommodation policy initiatives devised on this basis. It interprets developments in this regard as a movement from assimilationism to integrationism to (weak) multiculturalism. The article also reveals a significant “policy implementation deficit”, which is manifested in two ways. Firstly, accommodation output has generally failed to meet central government targets and has consistently failed to reduce the numbers of Travellers living in unofficial encampments. Secondly, the type of accommodation provided has often been at variance with central government recommendations. Thus, an assimilationist policy statement has effected multicultural policy outcomes, while a multiculturalist policy statement has effected assimilationist policy outcomes. These patterns of accommodation output are related to various implementation variables—some long‐standing, others new—which have impeded the implementation of national policy by actors on the ground.     

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?     

Which ethics for science and public policy?

The problem of inaccurate, misapplied or fraudulent scientific data could be addressed by government regulations, or by self‐regulation from within science itself. To many, self‐regulation implies the grounding of research activities in some “neutral”; standard of “ethics”; acceptable in a “pluralistic”; society. Yet, there is no such thing as a “neutral ethics”; and many “contemporary”; theories contain such serious theoretical deficiencies and contradictions that they are practically inapplicable. As a viable alternative to these theoretical and practical problems, an objectively based realistic framework of ethics is considered, and used to ground both the individual scientific and the collective public policy decision making processes. This is an ethics of properly integrated relationships. It is then applied to an analysis of many of the causes of incorrect scientific data, as well as of many of the internal and external pressures and abuses often experienced by scientists today. This approach respects the integrity of each decision maker as a human being and a moral agent—which in turn better insures the integrity of the protocol, the data, and the public policy decisions which follow—and ultimately, the integrity of the scientific enterprise itself. The alternative is government regulations.     

Programme form and service user well-being: Linking theory and evidence

Since the early 1990s, the “activation turn” has become a standard welfare orthodoxy at the heart of international welfare systems. Although policymakers talk confidently about the well-being gains of activation interventions and their employment outcomes, a growing body of research has focused instead on questions around “activation process well-being”—the potential well-being effects of participation in activation programmes themselves. The present article makes three main contributions to the theory, knowledge, and policy practice of this activation well-being literature. First, the paper develops an original conceptual framework that newly connects well-being theory, qualitative variation in programmatic form, and empirically testable well-being expectations for participating service users. Second, the paper uses multivariate statistical analyses to examine six conceptually derived hypotheses around variation in programme forms and implications for participating service users' well-being, drawing on the case study of U.K. activation policy. Noteworthy is the paper's unique distributional insights into well-being effects across different types of service users. Third, the paper offers new policy contributions around the relevance of policy form to service user well-being as well as important pointers to key programme features in this regard.     

"So Many Tiers, So Many Agendas, So Many Pots of Money": The Challenge of English Regionalization for Voluntary and Community Organizations

This paper looks at the challenges facing voluntary and community organizations (VCOs) within the new policy context of English “regionalism”, drawing primarily on an empirical study in one of the emerging Regions. Barriers to voluntary and community sector (VCS) engagement with the new regional governmental organizations and the new regional policy agenda are identified. The role of VCS “infrastructure” organizations in facilitating relationships with regional levels of government is also considered. The concepts of exchange, ownership, trust and legitimacy are then employed to analyse and explain the implications for English VCOs of working with a new tier of government at regional level. The paper concludes by reconsidering the nature of the relationship between VCOs and “government” in the light of the new policy context presented by English regionalism combined with central government interest in building the capacity and infrastructure of the voluntary sector.     

The Third Way and Social Welfare: The Myth of Post-emotionalism

The “passive” welfare state was accused of promoting a dependency culture. “Active” welfare and the “what works?” approach of Britain's New Labour government is allegedly implicated in an age of post‐emotionalism, in which people are largely indifferent to the needs of others and committed primarily to their personal well‐being. This article, first, seeks to extend recent debates about agency and motivation in social policy and relate them to the notion of post‐emotionalism. Second, it draws on a recent empirical study of popular and welfare provider discourses, which suggests that popular opinion can accommodate an appreciation of human interdependency, while welfare providers remain committed to a public service ethos. None the less, Third Way thinking is associated with a narrowing of solidaristic responsibilities. The problem for the future of health, social care and state welfare policies lies not with the imagined consequences of post‐emotionalism, so much as with an ideological context that perpetuates a distorted ethic of responsibility.     

Making welfare conditional: A street-level perspective

This article looks at how welfare conditionality is delivered at the street level. It argues that the street-level delivery of welfare conditionality is structured by policies, the governance context in which workers deliver welfare conditionality, the organization in which they work, and the occupation they are part of. Characteristics of these contexts present street-level workers with a variety of signals and incentives that direct their decision making. The article elaborates on this proposition on the basis of a review of academic studies analysing the street-level delivery of various aspects of welfare conditionality: the use of sanctions, service personalization, and the treatment of vulnerable clients. The review shows that context characteristics together have a significant impact on the street-level transformation of welfare conditionality policies into practices. Street-level decision making concerning the use of sanctions is far more complex than can be captured by a perspective on street-level workers as merely policy implementers. Sanctioning practices are sometimes harsher, sometimes more lenient than policies lead us to expect. The “soft” side of welfare conditionality—represented by service personalization—is often under pressure at the street level, potentially strengthening welfare conditionality's tough side. This affects vulnerable jobseekers most: Street-level studies show that the balance between disciplining and enabling aspects of welfare-to-work is most at risk for more vulnerable groups. The article concludes that the contextual pressures street-level workers have to deal with in their daily work hardly reflect the “delicate equilibrium” that they need to deliver welfare conditionality in a professional, responsive, and responsible way.     

"Risk" and UK Pension Reform

“Risk” is a word that has become common currency in the financial services industry in general, and in the pensions industry in particular. This article critically examines its use in the context of the current debate about UK pension reform. “Risk” is used by a broad spectrum of interests to discuss a wide range of pension issues in a variety of contexts. The article outlines key theoretical perspectives on the nature and construction, or conceptualization, of risk. Their relevance to debate and policy initiatives, particularly public pension policy, is examined. It is suggested that current government policy is failing to carry with it those to whom the policy applies; that reforms implicitly, if not explicitly, underestimate the importance of “security”; and that failure to conduct a much broader debate about the fundamental notions of work, retirement, saving and security may simply condemn the UK to interminable pension reform.     

全球治理:中国不干涉政策与国际法

一直以来,独立自主的和平外交政策是中国政府开展对外关系的基石,集中体现为坚定奉行不干涉政策。随着经济全球化进程以及中国"走出去"战略的不断推进,一方面,中国国家利益开始遍布海外,并与他国利益相互交织在一起;另一方面,中国参与全球治理也需要让渡部分主权性权利。越来越多的人认为,中国政府一味机械地固守不干涉政策似乎显得有点陈腐和过时。因此,在继续恪守不干涉他国内部事务和尊重他国主权等国际法基本原则的基础上,中国政府需要适时和灵活地调整以往对外严格奉行的不干涉政策,积极而创造性地介入国际事务,这对于其在新时期担负起"负责任大国"的角色、参与塑造新的世界秩序以及促进当代国际法的发展都具有十分重要的战略意义。     

Taking social policy personally: How does neuroticism affect welfare state attitudes?

The role of the “Big Five” personality traits in driving welfare state attitudes has received scant attention in social policy research. Yet neuroticism in particular—a disposition to stress, worry, and get nervous easily—is theoretically likely to be an important driver of welfare attitudes precisely because welfare states deliver social “security” and “safety” nets. Using cross-sectional data from the German Socio-Economic Panel, we study three distinct attitude types (dissatisfaction with the social security system, feelings of personal financial insecurity, and preferences for state provision) and multiple social need contexts (including unemployment, ill health, old age, and nursing care). Controlling for established explanations such as self-interest, partisanship, and socialization, neuroticism does not systematically affect support for state provision. But it robustly increases general dissatisfaction with social security, as well as financial insecurity across various need contexts. Neurotic people are thus less happy with welfare state programmes across the board, yet they also appear to need these programmes more. This trait may be an important deeper layer driving other social attitudes.     

Money and Swedish inflation

Analysing the role of money for Swedish inflation, we apply a single equation “P-Star” model and a structural VECM for the period of the late 1980s to the beginning of 2005. Against the background of theoretical and empirical considerations, we find that money – when measured by the “price gap” or, alternatively, the “money overhang” – had a statistically significant impact on future price movements. The results suggest that money might have to play a more prominent role in monetary policy making in Sweden compared with the status quo.     

Cash‐for‐care payments in Europe: Changes in resource allocation

Resource allocation has been a main policy issue in cash‐for‐care schemes (CfCs) for older people in Europe since their inception. It regards how publicly funded care benefits and services are distributed among older people. The raising pressures of an ageing population and the tensions on the financial sustainability of welfare regimes in place have further exacerbated the relevance of this topic over the recent years. Nevertheless, comparative research so far has overlooked changes in resource allocation in CfCs over time. This article contributes to fill this gap, exploring changes in resource allocation of CfCs for older people in a sample of European countries—Austria, England, France, Germany, Italy, and The Netherlands—since the early '90s (or since the introduction of the scheme). It examines three analytical dimensions: (a) The mix of public services and benefits provided to older people (CfCs, community services in kind, residential care); (b) the level of CfCs coverage; and (c) its generosity. A combined view of these dimensions leads to the discussion of two dilemmas: How to allocate the resources devoted to CfCs in the light of the trade‐off between its coverage and intensity? And, within the whole long‐term care system, how to allocate resources between CfCs and services in kind?     

“开禁”还是“飨宴”？--汉唐北宋赐酺举措缘起、背景与施行动因的再探讨

汉唐北宋时代的“酒禁”政策并不能直观地理解为“禁民饮酒”。“禁群饮”之举在当时虽有发生,却始终并非一项整体与长期的国家政策,在其已然宣布的时期之内,执行与贯彻的力度也大可存疑。笼统地以“酒禁”或“禁群饮”政策的存在来解释赐酺举措发生和存续的合理性缺乏说服力。酺会在汉唐北宋的不断发生、持续流行,根本原因在于其最为核心的内容与意义是飨宴欢会。其给民众带来更热烈的欢宴体验、更加丰富的公共活动内涵以及更为广大的社交活动平台,同时为统治者提供得力的政治工具。赐酺之举的丰富功能使得其能够横历不同王朝,长期存在。     

Comparing policy advisory systems beyond the OECD: models,dynamics and the second-generation research agenda

ABSTRACT

The concept of “policy advisory systems” was introduced by Halligan in 1995 as a way to characterize and analyze the multiple sources of policy advice utilized by governments in policy-making processes. The concept has proved useful and has influenced thinking about both the nature of policy work in different advisory venues as well as how these systems change over time. However, to date this work has examined mainly cases of developed countries and its application to developing and transitional countries is less certain. This paper sets out existing models of policy advisory systems based on Halligan’s original thinking on the subject and assesses the findings of many existing studies into OECD countries that advisory systems have been changing as a result of the dual effects of increased use of external consultants and others sources of advice – “externalization” – and the increased use of partisan advice inside government itself – “politicization”. Determining whether or not such changes have also characterized the situations found in developing and transitional countries and at the international-domestic and state-sub-state levels is the subject of the papers in this Special Issue.     

Slicing Up the Pie: Allocation of Central Government Funding of Care of Older People

The allocation of central government funds is a critical element in the equitable provision of local authority‐commissioned and ‐provided services. A variety of approaches to allocating funding for social services for older people have been used over the years, most recently founded on ‘needs‐based’ formulae. In 2004, the Department of Health for England commissioned research to help inform the improvement and updating of the formula. The results of individual‐level analyses were compared with the results obtained from analyses of small area (ward‐level) data on service users. Both analyses were affected by problems of data availability, particularly the individual‐level analysis, and the Department of Health and the (then) Office of the Deputy Prime Minister decided that the formula calculations should be based on the results of the small area analysis. However, despite the differences in approach, both methods produced very similar results. The correlation between the predicted relative needs weights for local authorities from the two models was 0.982. The article discusses the strengths and weaknesses of each approach and developments that could allow a normative approach that would incorporate future policy objectives into formulae that, to date, have inevitably been based on historical data and service patterns.