Motivation and Commissioning: Perceived and Expressed Motivations of Care Home Providers

Commissioning of social care for older people has seen major changes since the early 1990s. Considerable responsibility now rests with local authority staff, whose views of care home providers’ motivations, their perceived strengths and weaknesses as service providers, will have a bearing on commissioning decisions. We examine commissioners’ views of provider motivations in eight English local authorities and compare their perceived motivations with providers’ expressed motives. Data were collected through semi‐structured face‐to‐face interviews with commissioners and care home providers. Providers are generally perceived by commissioners as highly altruistic, but also relatively financially motivated individuals. Further analysis revealed significantly different views towards profit‐maximizing, which commissioners perceive as very important, while providers consider it to be of little motivational value. Private sector providers are described by commissioners as significantly more motivated by personal income. Associations are found between commissioners’ perceptions of motivations and the nature of their relationships with providers. Perceptions of providers’ motivations appear important within the commissioning framework.     

Organizational Form as a Mechanism to Involve Staff,Public and Users in Public Services: A Study of the Governance of NHS Foundation Trusts

In addition to introducing markets and market‐like structures into public services, New Labour wished to promote the involvement of users and the public in decision‐making in other ways than as individual consumers. One way was to involve the public in the governance of organizations. This could be done by removing public services from state control, and transferring them to mutual ownership; or by increasing public involvement in the governance of public bodies. NHS foundation trusts (FTs) were presented as mutuals. Our study shows FTs are not mutuals, as they continue to be owned by the state. Moreover, staff of FTs were generally not engaging with the new governance structures. In general, there was mixed experience of the new structures enabling governors to increase accountability of the hospitals to the public. On the other hand, having a membership did enhance the legitimacy of FTs, as opposed to other NHS organizations. The findings of the study are of current interest as the coalition government is continuing with the policy of FTs, and also encouraging mutuals and other forms of public involvement.     

Network governance among actors involved in the government’s contracting out of foster care services: A case study in China

The government's contracting out of foster care services in Guangzhou, China, introduced the possibility of partnerships between nongovernmental organizations (NGOs) and government-led human services. To understand network governance among actors involved in contracting out foster care services, service funders, service providers, and service users were interviewed. A thematic analysis of interviews combined with a critical review of archival data was conducted. Drawing from the policy network governance analytic framework, we found that network governance conditions in contracting out foster care services were characterized by close interdependence among actors, moderate standardization in work duties, but nonreciprocal patterns of interactions, and low to modest levels of autonomy, along with strong power in the government but limited self-governance among NGOs and foster families. Our findings indicate that network governance was not fully achieved among actors involved in the contracting out of foster care services. Implications for practice and research are discussed.     

Integrated care and the ‘agentification’ of the English National Health Service

Integrated care is a global reform principle for improving patient access and outcomes by ensuring that healthcare organisations deliver services in a joined‐up, person‐centred way. Following reforms designed to infuse agency within English National Health Service (NHS) organisations, the agenda for integration must come to grips with the different approaches to joint working that these organisations mobilise, and the compatibility of their different agentic orientations. We build a matrix for identifying the extent to which different forms of agency orient nine NHS organisational types. Interrogating the Strategic and Operational Plans of these organisations for the period 2015–2018 based on questions derived from the matrix, we associate each organisation with one of eight generalised models. Assuming that there is greater potential for integration where organisations mobilise similar forms of agency, we discuss the incentives and potential governance changes that policy makers might consider to enhance integrative potential.     

Re‐imagining public service

We live at a time marked by growing distrust of democratic institutions and increasing threats to those Enlightenment values that afford the individual protection from the arbitrary exercise of authoritarian power. In the face of such challenges, we need to re‐imagine more agile, adaptive and responsive forms of governance. This edited speech argues that with sufficient political authority, public services can facilitate the commissioning of programme delivery, cross‐sectoral collaboration, new forms of social investment in public good and more opportunities for participatory engagement by citizens.     

The changing relationship between the Chinese Government and Non-governmental Organisations in social service delivery: approaching partnership?

Using the Guangzhou social governance reform pilot as a case, this paper aims to explore the transformation of Chinese governments in managing collaborative non-governmental organisation (NGO) relationships. Local governments have adopted multiple new governance tools, and the expansion of the NGO sector with genuine grassroots development has been observed. However, valuable principles of New Public Management (NPM) paradigm have not been followed, and strong authoritarian and bureaucratic practices have been revealed. The state–NGO relationship has moved from a typical statist to a state-corporatist model. Findings indicate distinctive features of Asian public administration and the limitations of applying Westernized NPM models.     

Social service purchasing in China: Rationale,features, and risks

As part of a broader program of market reform, China's local governments are progressing an agenda of purchasing child welfare and other social services from the nongovernment sector, primarily to expand capacity and address vast unmet need. This paper draws on current research evidence to explore the approaches to purchasing emerging in China, examining the rationale for purchasing and models of supply, competition, and regulation. While some approaches are modeled on direct service contracting, direct purchasing of social service “posts” is also used, aimed at achieving goals of professionalization alongside service expansion. Overall, the review shows purchasing is helping to rapidly expand service scale and capacity; however, regulatory strategies for managing and mitigating risks to quality and access appear lacking. This highlights the need for further scholarship aimed at developing the robust risk management strategies which are required to support high quality, sustainable provision of purchased services.     

Choosing Whether to Buy or Make: The Contracting Out of Employment Reintegration Services by Dutch Municipalities

The Western welfare states are under reform. An important part of these reforms is the introduction of market type mechanisms for the deliverance of public services. Over the years, many countries have chosen to contract out employment reintegration services. The underlying notion of contracting out is the belief that the introduction of market elements in the production of public services increases effectiveness and efficiency. In addition to the cost benefit argument for contracting out public services, ideology is often brought forward as an important factor explaining why public services are provided in‐house. In this article, we analyze to what extent cost benefit arguments and ideology affect the make or buy decision of Dutch municipalities. The Dutch employment reintegration market poses an interesting case in point since Dutch municipalities have the option to either provide employment reintegration services themselves or to buy services on the market. Our analysis shows that cost benefit arguments do not play a role in the make or buy decision of Dutch municipalities. Ideology, however, does. Municipalities that adhere to the principles of New Public Management more often opt to buy employment reintegration services on the market. Also the outcomes of municipal elections have been found to be of importance – left‐wing municipalities more often choose in‐house service provision.     

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.     

Events,Politics and Patterns of Policy‐Making: Impact of Major Incidents on Health Sector Regulatory Reforms in the UK and Japan

This article examines the major malpractice incidents in the late 1990s through early 2000s in the UK and Japan, comparing how these incidents opened up pathways for a new type of hospital regulation in each case. Applying John Kingdon's three‐stream model of agenda‐setting and policy change, the article argues that governance arrangements as well as the policy instruments that a government has at its disposal determine how an event could be translated into a political agenda by throwing light on the problems within the public domain. The long‐term effect of such adverse events is therefore determined by how open the relevant institutional arrangements are, and is enhanced if actors constantly scrutinize the system by proactively setting the agenda. A higher level of political accountability in the UK led to British politicians taking a greater role in promoting patient‐led reforms than Japanese counterparts. However, a political system with clear accountability is more conscious of its own involvement and any potential blame it might receive for policy failures. Therefore, the political class could become more engaged in continuous reforms and the delegation of tasks rather than a constant search for remedial actions. The article sheds light on the interactive aspects of the particular triggering events discussed through the decade of regulatory developments in the two health‐care systems.     

Improving Service Delivery in Education Through Collaboration: An Exploratory Study of the Role of Cross‐Sectoral Alliances in the Development and Support of Charter Schools*

Objective. This article explores cross‐sectoral alliances as mechanisms for enhancing service delivery in public education. We assess the extent to which the three economic sectors—nonprofit, for‐profit, and public—are involved in partnerships with charter schools and identify the benefits that charter schools receive from partnering with other organizations. Methods. The study utilized a qualitative approach: data collection involved interviews with charter school experts in 37 states. Results. We found that organizations from each of the three economic sectors were involved in alliances with charter schools and that these alliances offered a range of financial (e.g., facilities, salaries), political (e.g., legitimacy, credibility), and organizational (e.g., curriculum, management) benefits. Conclusions. Our findings from this exploratory study suggest that cross‐sectoral alliances have the potential to enhance the capacity of charter schools to deliver high‐quality educational services. Three hypotheses generated from the findings are also offered to guide future research on charter school alliances.     

Patterns of Governance: The Curious Case of Non-profit Community Services in Australia

"Community" has taken on a new significance in Australian social policy discourse. Seemingly sound and morally justifiable, in the context of neo-liberalism the language of community positions non-profit delivery of services as superior to state-provided services. As a consequence, non-profit community services are being centrally positioned to mediate the relationship between the state and citizen subjects. In the first part of this paper we trace some of the key historical developments in Australia's welfare state and patterns of governance that are propelling the non-profit sector from the margins to the centre. The second section examines the relationship between Australia's shifting political landscape and the emerging welfare regime. One key feature of this new regime is the attempt to relocate citizenship away from the domain of the state and into that of civil society. The article concludes by sketching out some research themes, focusing, for example, on the impact of devolution of governance in terms of client rights and public accountability.     

Economic Determinants of Voting in an Era of Union Decline*

Objective. The objective of this article is to test competing hypotheses regarding union vote effects by economic sector. Overlooked in existing research on political participation and the labor movement is de‐unionization's sectoral dimension: declining union rolls is a private‐sector phenomenon. The sectoral dimension of union decline carries important political consequences if the influence of unions on voter turnout varies by sector. Method. Using Current Population Survey (CPS) November Voting and Registration Supplements for all national elections between 1984 and 2006, I estimate union vote effects for public‐ and private‐sector employees. Results. The results of the analyses reveal that while union members continue to vote at higher rates than otherwise similar nonmembers, the union effect is nearly three times as large for private‐sector members: private‐sector unionists have a predicted probability of voting 6.7 points higher than nonmembers, while public‐sector members have a predicted probability of voting only 2.4 points higher than nonmembers. Conclusions. Given the small fraction of private‐sector workers now in labor unions, recent fluctuations in the unionization rate have little aggregate affect on turnout. Given that private‐sector union members tend to be less educated and earn less than their public‐sector counterparts, the near disappearance of private‐sector unions from the economic landscape removes an important institutional buffer against political inequality in the United States.     

Community service provision for the elderly under the context of competitive contracting in Guangzhou

Contracting is a prevalent trend in the delivery of public and social services around the world. International experience shows that contracting has positive and negative impacts on service provision. While local experiments on social service contracting are currently emerging in China, the implementation and effects of contracting are worthy subjects of examination. This study delves into this area by focusing on community service provision for the elderly in the context of competitive contracting. A street community which is located in Guangzhou, Guangdong Province of China serves as a case study to show the implementation of competitive contracting, the provision of community service for the elderly, and the implications of contracting for care.     

Is Contracting out of Public Services still the Great Panacea? A Systematic Review of Studies on Economic and Quality Effects from 2000 to 2014

This article presents the results of a systematic review of international studies on economic and quality effects of contracting out published in the period from 2000 to 2014. We conducted a comprehensive search of the literature and identified 49 relevant studies. There are three main findings of the systematic review: (1) cost savings documented in international contracting out literature have been decreasing over time; (2) cost savings have been much greater in technical services than in social services; and (3) economic effects have been twice as large in Anglo‐Saxon countries compared with other countries. With regard to measuring the effect of contracting out on service quality, which is a vital component of any service delivery arrangement, very few studies assess this issue in a comprehensive manner. There is also a significant lack of studies that include measures of transaction costs, thereby making it difficult to evaluate the impact of contracting out on overall cost‐effectiveness of public service delivery. We conclude that generalization of effects from contracting out should be made with caution and are likely to depend, among other things, on the transaction costs characteristics of the service, the market situation and the institutional/regulatory setting.     

Mixed accountability within new public governance: The case of a personalized welfare scheme in early implementation

We explore personalized funding schemes and associated changes for accountability within new welfare governance reforms. Using the case of the Australian National Disability Insurance Scheme as hybrid institution, requiring mixed accountability arrangements, we examine the implications for broader discussions of accountability in personalized welfare arrangements. Methods used were semistructured interviews with government actors and disability service providers in Australia. In describing how accountability structures emerge, we argue that the way that layers fit together during implementation are often imperfect because of the conditions under which they arise. As a result, critical gaps can emerge in layered systems, which can put end users at risk. We demonstrate that theories on accountability in new public governance welfare reforms must also be informed by context and history informed qualitative analysis of case studies.     

From quasi‐markets to public–private networks: Employers' engagement in public employment services

This article explores the implications of creating a role for private‐sector partners in public employment services (PES), rather than creating quasi‐markets. It focuses on how the engagement of employers in public–private networks with local government can enhance employment opportunities for disadvantaged welfare recipients but may require a further shift in local public services. The theory relates to contractual arrangements versus network modes of public–private partnerships. Based on surveys among employers and welfare recipients, and interviews with politicians, managers, and frontline workers in five Dutch municipalities, the article provides detailed evidence on innovative and promising cases of public–private networks in employment services. It shows that, under certain conditions, vulnerable jobseekers are better served by a network involving employers than by the standard supply‐driven approach that predominates in quasi‐markets. It also reveals that public and private partners have yet to fully embrace the implications of the network approach for their respective roles. The article contributes to the theoretical debate on public–private partnerships in the context of PES, reflecting on public–private networks as a policy design that could help improve employment opportunities for disadvantaged jobseekers.     

Micro‐provision of Social Care Support for Marginalized Communities – Filling the Gap or Building Bridges to the Mainstream?

As English social care services reconstruct themselves in response to the personalization agenda, there is increased interest in the contribution of micro‐providers – very small community‐based organizations, which can work directly with individuals. These micro‐providers are assumed to be able to cater for the ‘seldom heard’ groups which have been marginalized within mainstream social care services. This article reviews recent literature from the UK published in peer‐reviewed journals from 2000 to 2013 on support provision for people with protected characteristics under the Equality Act 2010. It considers the marginalising dynamics in mainstream, statutory social care support provision, and how far local community, specialist or small‐scale services are responding to unmet need for support and advice among marginalized groups. The review found that there is a tradition of compensatory self‐organization, use of informal networks and a mobilization of social capital for all these groups in response to marginalization from mainstream, statutory services. This requires recognition and nurturing in ways that do not stifle its unique nature. Specialist and community‐based micro‐providers can contribute to a wider range of choices for people who feel larger, mainstream services are not suitable or accessible. However, the types of compensatory activity identified in the research need recognition and investment, and its existence does not imply that the mainstream should not address marginalization.     

北京市合同能源管理现状分析及思考

随着20世纪末合同能源管理模式进入中国,北京市的节能服务产业已初具规模且整体实力较强。在国家政策支持的基础上,北京市政府也进行了大力的政策扶持,并搭建起合同能源管理支撑服务体系,首批示范改造项目节能效果显著。然而,在推行合同能源管理过程中也暴露出一些问题,需要采取措施使其得到长足发展。     

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.