‘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.     

The restructuring of WA human services and its implications for the not‐for‐profit sector

Western Australia provides an interesting case study of the outsourcing of human services to the not‐for‐profit (NfP) sector. This article presents and discusses some of the key themes that emerged from a recently completed research project examining one large NfP in Western Australia. Key themes included the recruitment and retention of staff linked to pay and changing funding arrangements, and the sector becoming increasingly corporatised in outlook and goal orientaiton. Despite evidence that the shifting policy and funding environment within the NfP sector has had some negative consequences, the research findings highlight a degree of agency within which organisations can resist or counterbalance these changes. Efforts to avoid this trend, however, are reliant upon a number of factors; for example, a strong commitment to vision and mission supported by skilled leadership and adequate resourcing. Significantly, these factors are unlikely to be readily available, particularly for smaller NfPs. This discrepancy in organisational capacity is set to become more conspicuous with the potential introduction of ‘Big Society’ policies derived from the United Kingdom, and funding cuts proposed by the Coalition government.     

When I hurt others,and when I get hurt: Integrating victim and perpetrator experiences of harm into a sense of moral agency

In a social world, occasionally we all will harm others, as well as be harmed. Previous research has focused largely on how perpetration and victimization events are distinct rather than on how they might be integrated with one another, jointly shaping moral agency. We report on an exploratory qualitative analysis of narratives about perpetration and victimization. Our sample included 30 participants divided evenly by gender and age (ages 11–12, 16–17, and 19–26). Our aims were: (a) to identify potential forms of integration in moral agency across perpetration and victimization; (b) to explore developmental paths in integration; and (c) to examine forms of integration that were not tied directly to the construction of moral agency. We found three frequent integration patterns: harm was similarly understandable in perpetrator and victim narratives; harm was similarly incomprehensible in perpetrator and victim narratives; and harm was understandable in perpetration narratives but incomprehensible in victim narratives. Other forms of integration suggestive of how diminished moral agency can be reclaimed via narrative also were identified.     

Emotion in responses to the child with ‘additional needs’

The work that is done with children and young people by the practitioners of health, education or social care forms part of their experience of growing up, and can have a profound impact on their future outcomes. Children may find themselves ‘impotent at the hands of powerful others’, particularly where their behaviour causes concern. This paper reports on a key theme from the author's doctoral research, demonstrating the ways that the emotion‐laden interactions between practitioners in multi‐agency children's services, children and parents, affected the diagnosis, treatment, communication and outcomes for children's well‐being, as defined within Every Child Matters. Exploring the emotion within interactions permits a different perspective on ‘need’, and finally, the paper argues for a more careful and emotionally reflective practice from those who work with children.     

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.     

The influence of faith‐based organisations on Australian social policy

This historical overview explores the crucial and changing relationships between faith‐based organisations and governments, not only in the implementation of social services but also in the formation of social policy. Historically Australian governments have left large areas of social provision to the non‐government sector. For example, income support for the unemployed was not taken up by governments until World War II and income support for sole parents remained largely a responsibility for non‐government organisations (NGOs) until the 1970s. Prior to governments taking responsibility for income support, most of these NGOs were religious organisations surviving on donations, philanthropic support and limited government funding. It is argued that the dominant, semi‐public role of religious organisations in service delivery and social policy formation is an important but largely overlooked aspect of the Australian historical experience.     

Activation Reform and Inter‐Agency Co‐operation – Local Consequences of Mixed Modes of Governance in Sweden

Organizational reform has become a recurring solution to problems of social exclusion and unemployment. In Europe, and other parts of the world, there is a trend towards policies of ‘activation’ in employment and social policy. The idea of flexible, individualized and tailor‐made services is coupled with managerial and market‐based reforms as well as collaborative governance. In these complex structures of service provision, coordination and inter‐agency co‐operation have become key concerns. Based on a study of a recent reform of programmes for newly arrived refugees in Sweden (Etableringsreformen), this article seeks to contribute to the literature on governance of ‘activation’ by examining the consequences of mixed modes of governance (market and collaborative) on local inter‐agency co‐operation. Drawing on data from in‐depth case studies in two municipalities, it is demonstrated how the coupling of managerial practices and quasi‐markets with existing collaborative arrangements has created barriers for inter‐agency co‐operation. The results indicate that institutional tensions between governance forms represent an important factor for explaining governance failure in this policy area.     

Garbage‐can Policy‐making Meets Neo‐liberal Ideology: Twenty Five Years of Redundant Reform of the English National Health Service

The garbage‐can theory of decision‐making (Cohen et al. 1972), has been adapted into a perspective on policy‐making, with adaptations of the approach placing notable emphasis upon the health sector (Kingdon 2006; Paton 2006). This article creates an adapted ‘garbage‐can’ framework to help explain each stage of the reform of the English National Health Service (NHS) over the last 25 years. The emergence of the key idea and resultant policy at each stage of reform of the English NHS has been arational and indeed sometimes irrational. Policy has reflected advocacy by policy‐salesmen (Kingdon 2002), proffering ‘solutions’ to ill‐defined problems and answers to unasked questions, and politicians' short‐termist responses at each decision‐point. Yet the garbage‐can alone is not enough: if arationality rules in policy‐making day to day, this does not mean that there is not an overall ideological context, trend or bias in reform. The article also posits that ‘market reform’ has derived from the ideological hegemony of a naive anti‐statism (hostility to a misleadingly defined and often mythological ‘centralist state’) in public services and enthusiasm for market competition rather than any evidence‐based application of pro‐market ideas to health policy. A question arises: how are these two approaches (short‐term arationality and longer‐term ideological bias) combined in explanation of how policy over time is biased in a particular direction while seemingly arbitrary and directionless at each messy decision‐point. The article attempts to combine the insights of a garbage‐can approach with wider explanations of ideological hegemony.     

The proof of the pudding: What difference does multi‐agency working make to families with disabled children with complex health care needs?

More than 20 years of research with disabled children, young people and their families has highlighted the need for the different professionals and services that support them to work more closely together. The British policy and legal framework for ‘joined up working’ has never been stronger. However, there has been an assumption that multi‐ or inter‐agency working will inevitably be a ‘good thing’ for families. This paper discusses findings from a 3‐year research project which looked at both the process and impact of multi‐agency working on families with a disabled child with complex health care needs. Interviews with 25 parents and 18 children and young people who used six developed, multi‐agency services were carried out. Findings suggested that the services had made a big difference to the health care needs of disabled children but were less able to meet the wider needs of the child and the family – particularly in relation to social and emotional needs. Multi‐agency working appeared to make some positive, but not significant, differences to the lives of families.     

Empowering refugees and asylum seekers in the Italian agriculture sector by linking social cooperative entrepreneurship and social work practices

The present study investigated the potential of social cooperative activities and social work practices in the Italian agriculture sector in promoting sustainable integration forms for refugees and asylum seekers. The study adopted a qualitative approach using case study as the main research method. As the results show, the complexity and diversity of needs of refugees and asylum seekers make collaboration between formal and informal actors increasingly necessary for generating a common knowledge and support networks. The article argues that integrated approaches to refugees’ socio‐economic integration are needed to free them from the need for assistance and thereby help them regain their autonomy. The case study presented gives insight into the potential of small‐step experiences towards sustainable development and, linked to this, the integration of refugees and asylum seekers based on self‐organisation and cooperation, considering the well‐being of all citizens in the broader context.     

Agency‐Based Support: A “Last‐Resort” Strategy for Low‐Income Families?*

Objectives. Agency‐based support, defined as material assistance received from charities and private social service agencies, can constitute an important source of help for low‐income families. This study examines the socioeconomic determinants of agency‐based support and seeks to reveal whether it constitutes an alternative source of support for families whose personal networks can provide only limited assistance. Methods. Multivariate analyses were conducted using data from “Welfare, Children, and Families: A Three City Study,” a study of low‐income mothers living in disadvantaged urban neighborhoods. Results. Findings reveal that respondents with high levels of network support were significantly less likely to use agency‐based support. No association, however, was found with network burden, which led to rejecting the alternative hypothesis that people may use agency‐based support to limit their interactions with demanding network members. Conclusions. Overall, findings suggest that agency‐based support constitutes an alternative source of assistance for those who receive little or no support from family and friends. Policy implications in light of welfare reform are discussed.     

Toward a Dialogical Perspective on Agency

The aim of this article is to motivate and outline a dialogical perspective on agency that accommodates centrifugal and centripetal tendencies in current cultural theories of agency. To complement approaches that assume a high degree of integration and clarity, we emphasise the diversity of agency as it is experienced in the open-ended dialogical relationship with a particular other. While these former approaches to agency provide us with the means to examine the influence of social processes such as division of labour and reproduction of community, they tend to underplay the importance of agency as it is embodied and experienced in the lives of particular people. To reflect on this aspect of agency, we will draw extensively on Bakhtin's work, which crosses boundaries between philosophy, psychology and literary criticism, and which is concerned to understand what is personal in activity. In terms of agency, his work draws our attention to the sense of responsibility and potentiality that imbues our dialogues with particular others, the aesthetics and ethics involved in dialoguing with the other, and the sense of dilemmatic choice and intonation that is involved in our dialogue with the other.     

Faith‐based organisations and social policy in Melanesia

This paper examines the contribution that faith‐based organisations (FBOs) make to social policy in Papua New Guinea, the Solomon Islands, Vanuatu and Fiji. The paper sets contemporary relationships between church and state in these independent states of Melanesia in their individual historical contexts of missionisation, colonisation and decolonisation. Since independence these sovereign nations have relied on the networks and social capital of faith‐based communities and organisations in policy implementation in critical areas such as health and education. FBOs, for their part, have endeavoured to participate in policy and programme implementation without losing their autonomy. This pattern of selective cooperation has produced a unique policy environment, in which policy coordination continues to challenge government officials. Despite close association between FBOs and social policy in the Melanesian states, the slow progress with human development indicators and the Millennium Development Goals highlights the need to find more effective approaches to agenda‐setting, policy articulation and implementation.     

Rethinking The Care‐Market Relationship In Care Provider Organisations

Care provider organisations are under pressure from funding bodies and regulatory procedures to narrowly construct care in ways that preclude its relational, emotional and social characteristics. This process of subjecting care to a managerialist‐market logic, however, creates tensions between the organisation and its key stakeholders: care recipients, care‐workers and unpaid carers. These tensions are significant and are likely to place organisations under pressure to develop a more holistic approach to care. In addressing this issue, this paper draws upon the concept of bounded emotionality to argue that it is feasible for organisations to be both instrumental and caring, and thereby be responsive to the needs of all of their stakeholders. The paper concludes by discussing some of the practical implications of organisations adopting a framework of bounded emotionality, and suggesting some directions for future research.     

Commercial,non‐profit and governmental residential elderly care in Flanders: Differences in client selection and efficiency?

Verschuere B, Moray N, Decramer A. Commercial, non‐profit and governmental residential elderly care in Flanders: differences in client selection and efficiency? Inspired by New Public Management, governments have stimulated competition, outsourcing and privatisation in the public sector. Also, in care of the elderly, there has been a substantial increase in commercial provision. The present study explored the presumed differences in the performance of public (governmental), private non‐profit and private commercial elderly care organisations. We used quantitative indicators on the population of residential elderly care organisations in Flanders (Belgium). Although we found that commercial elderly care facilities tended to be more input‐efficient while non‐profit and public elderly care facilities tended to be more attentive to recruiting and housing residents with high care needs, these results need to be interpreted in light of the regulatory framework in which the different types of elderly care facilities operate.     

Push‐Pull Factors and Immigrant Political Integration in Germany*

Objectives. Drawing specifically on the German case, I argue that individuals' motivations for immigration, or so‐called push‐pull factors, have a lasting impact beyond the decision to immigrate and, in fact, profoundly influence immigrants' political integration in the host country. Specifically, economic push‐pull factors are likely to impede immigrants' political integration, whereas political push‐pull factors lead immigrants to remain more interested and engaged in politics while abroad. Methods. I test these hypotheses using a combination of qualitative interviews conducted in 2002 with first‐generation Turkish immigrants living in Berlin, and quantitative survey data from the 1998 German Socio‐Economic Panel (GSOEP). Results. Results from both analyses lend considerable support to these assertions. Conclusions. The positive findings suggest that factors unique to the immigrant experience contribute to a fundamentally different understanding of immigrants' political integration from that of natives.     

Does Sexual Harassment Training Change Attitudes? A View from the Federal Level*

Objective. Employment‐related sexual harassment imposes large costs on both workers and their employers and many organizations have responded by implementing formal policies, grievance procedures, or training programs. However, limited evaluation of these interventions leaves us knowing very little about their impact. Our goal is to add to this limited empirical literature by analyzing the relationship between sexual harassment training and employees' views about what behaviors in fact constitute sexual harassment. Method. We use probit analysis and data drawn from the U.S. Merit Systems Protection Board (USMSPB) of the U.S. federal government to determine—separately by gender—the impact of sexual harassment training on the propensity of workers to define specific unwanted sexual behaviors in the workplace as forms of sexual harassment. Results. We find that sexual harassment training is associated with an increased probability—particularly for men—of considering unwanted sexual gestures, remarks, touching, and pressure for dates to be a form of sexual harassment. We also find that the proportion of agency staff receiving training is positively related to the propensity that an individual employee has a definition of sexual harassment that includes these forms of unwanted sexual behavior. Conclusions. Our results suggest that sexual harassment training programs may be useful in leading workers to be more sensitive to the issue of sexual harassment. Widespread training within the agency has an effect over and above that attributable to the individual's receipt of training itself and training appears to be particularly successful in clarifying men's views about the “gray” area generated by unwanted sexual behavior originating with co‐workers rather than supervisors.     

Seventy Years of Privatizing the British National Health Service?

The existence of different and conflicting definitions and different types, but few clear measures, of privatization has contributed to different interpretations of the extent of privatization in the almost 70‐year history of the British National Health Service (NHS). This article aims to examine the extent of privatization in the NHS over successive policy chronologies through the lens of the ‘three dimensional’ approach of the Mixed Economy of Welfare. We find that whilst privatization in the NHS is not new, the generally accepted view that it has increased in recent years appears valid, although precision is difficult due to the lack of a generally accepted typology or measure.     

Non‐governmental organisations and informal associations in service delivery for African migrants in China: Evidence of voluntary sector failure?

As the Chinese government has purposefully built economic, social and political links with several African states in recent decades, new patterns of international migration have emerged. Notably, mixed‐race families are increasingly visible in southern China, particularly Guangzhou, where there is a concentration of African traders. The few existing studies on this population have failed to pay attention to how, in the absence of state provision of or support for key public resources including health care and education, African‐Chinese families are raising their children. We examined factors contributing to NGO successes and failures in facilitating these families’ wellbeing and integration into mainstream society, drawing on the theory of voluntary sector failure. Mixed‐raced families are relatively isolated from mainstream society as well as formal/informal civil society organisations. We found select features of philanthropic paternalism, philanthropic amateurism, and what we term philanthropic mistrust, with implications for understanding voluntary sector growth in the Chinese context.