Suchergebnisse

Adult social care was the first major social policy domain in England to be transferred from the state to the market. This book meticulously charts this shift, challenges the dominant market paradigm, explores alternative models for a post-Covid-19 future and locates the debate within the wider political thinking and policy change literature.

The NHS is facing a combination of lower spending and increasing demand. In response, NHS England is requiring local areas to substantially rethink and reshape services through Sustainability and Transformation Plans. These have been devised largely without the involvement of patients and citizens, giving rise to widespread concerns about service loss. Other structural changes are also taking place that have no obvious place for citizen engagement. All of this is highlighting the problem of a lack of local accountability and legitimacy for decision-making in healthcare. This commentary describes the changes, identifies the accountability gap and suggests a framework for future development.

Public services are being increasingly outsourced across Europe, and especially in England. This trend raises the question of how to deal with 'market failure' where outsourced providers are no longer able or willing to continue with provision. The case of social care and health care in England is a critical policy arena. Following the collapse of Southern Cross – a major care provider – in 2011, policies on stronger provider regulation have been put in train in an attempt to forestall potential service failure. This commentary examines these proposals, concludes that they are insufficiently robust and suggests some alternative measures.

The reforms to children's services in the UK brought in by the Every Child Matters Green Paper and the subsequent Children Act 2004 represent the most significant change in this area of social policy since 1948. The policy approach has two distinguishing features – an 'outcomes led' approach rooted in the views of children and young people about what constitutes 'wellbeing' in their lives, and a partnership approach that recognises these outcomes can only be achieved through high levels of inter-agency and inter-professional working. This article suggests that the two features may be in tension, and that during the process of implementation there is a danger that user defined outcomes will be re-interpreted to fit in with other organisational and professional agendas. The analysis draws upon Rick Matland's framework for exploring the impact of conflict and ambiguity respectively upon the implementation process.

Context: In 2006 the Labour Government in England published its long awaited White Paper on 'community services', following on from the 2005 Green Paper on the future of social care. The policy envisages an unprecedented shift of activity and resources from acute care to community settings, along with a much stronger focus on preventive care. Several mechanisms are to be put in place to ensure this shift takes place, most notably practice-based commissioning, payments-by-results and enhanced partnership working. Purpose: This article outlines the intended changes and assesses the extent to which they add up to a coherent strategy. Conclusion: It is argued that although there is widespread support for the overall vision, the strategy contains some difficult policy tensions that are common to other welfare systems. These will have to be addressed if the vision is to be a reality.