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public services. Some critical consideration of the political uses of ‘choice’ and
markets is included here.
Whitehall, the National Health Service, local government, the police,
welfare and schools are the key public services considered in Part 3. The civil
service has been subject to a combination of ‘constant change and deep inertia’
(p. 109). Burton skilfully highlights the multiplicity of factors involved including
ministerial short-termism, the ‘cumbersome’ civil service, silo mentalities and
the proliferation of non-departmental public bodies. A number of case studies
make up the chapter on local government, including the errors of short-
termism whereby Labour’s ‘Total Place’ pilots for pooling budgets were swiftly
cut by the Coalition, only to be resurrected as ‘Whole Place’ community
budgets. The last two chapters could be expanded, given the highly politicized
nature of welfare and education reforms. A glaring omission is the politically
charged introduction and subsequent increases in tuition fees for higher
education.
Part 4 is shorter than the other parts, and briefly addresses measuring and
monitoring performance, and the international context. The first two chapters
in this section describe the perverse incentives that emerged from Labour’s
strongly centralized target culture, which was subsequently reduced by later
Labour administrations and especially by the Coalition. There are implications
for accountability in the Coalition’s preference for members of the public to act
as ‘armchair auditors’ rather than measurement and monitoring by central
government. This has led the Public Accounts Committee to criticize the policy
of ‘data dumping’ online, which can be ‘incomprehensible to the ordinary
member of the public’ (p. 238). The international context chapter provides
some insights but feels tacked on and does not go into enough comparative
depth.
In sum, Burton’s account is an ambitious and largely successfully realized
overview of public sector reform, but is ultimately weakened by an implicit
acceptance of the case for austerity and offers only a cursory discussion of
some of the criticisms of public sector reforms. Austerity politics, challenged
elsewhere (see Hay 2013), is not critically considered in this book. Without a
deeper engagement with austerity, and related debates such as ideologically
driven welfare state retrenchment, the particular motives behind, and out-
comes of, private sector involvement in delivering public services, and the role
of a neo-liberal form of managerialism that guides much public sector policy-
making, the politics of public sector reform is underplayed. Nonetheless, Bur-
ton’s book has a huge scope which may preclude this amount of critical depth,
and it provides an accessible, insightful, broad ranging and historically
contextualized entry point into current debates about public sector reform.
References
Hay, C. (2013), ‘The British growth crisis: a crisis of and for growth’, SPERI Paper No.1,
http: / / speri.dept.shef.ac.uk/ wp-content/ uploads/ 2013/ 01/SPERI-Paper-No.-1-
%E2%80%93-The-British-Growth-Crisis-FINAL1.pdf (accessed 2 September
2013).
action, family relations and justice across the generations and the search for
new sustainable ways of being.
The chapters themselves explore the contexts and histories of welfare and
the questions which repeat themselves. Jordan and Drakeford illuminate the
discourses associated with privileging certain expectations such as employ-
ment and marriage, pointing out the dichotomies and contradictions created
when considering childcare and family care. Whilst some within the Coalition
government or, indeed, amongst the Labour opposition may, no doubt,
dismiss the book as a political exercise, they would be hard-pressed to discount
its measured messages, preparedness to seek new ways of practising social
welfare and enacting policy.
One thing I think has been missed from the work and would strengthen its
thesis, is a discussion of the potential of capabilities which, unfortunately, is
relegated to one or two passing references. Creating such a discussion would
allow Jordan and Drakeford to focus on the development of resources of
people and communities to construct novel approaches to welfare and local-
ized policies and to seek the sustainability that is recognized and sought in a
new redistributive framework.
The importance for the disciplines of social policy and social work rests in
it drawing attention again to the intertwined relationship of social work and
state and the tensions thus created which can, if not checked and resisted by
the many excellent social workers and others enacting social policies on the
UK, lead to the curtailment of freedoms for wider society and people who, for
whatever reason, are marginalized or disenfranchised.
This is a book which I have recommended to students on my history of
social welfare course and, although contextualized by the time, will continue
to do so as it exemplifies the evolving constructions of welfare and thought in
the UK.
This book takes the reader on a journey across European health and social
care systems with the mission of integrating and clarifying evidence on an
under-researched and yet politically salient phenomenon – decentralization.
Costa-Font and Greer bring together seminal theoretical debates and empiri-
cal findings from the fields of economics and political science to chart out a
new exciting area of research – the political economy of decentralization and
health. They clearly define decentralization as ‘a change in the allocation of
authority in which powers shift to smaller territorial units of government’.
They then formulate three guiding questions, which are addressed consis-
tently in ten country-specific chapters: ‘what does decentralization mean, why
does it happen, and what are its effects?’.
The first part of the journey covers tax-funded systems and takes the
reader from the south to the north of Europe. Gilberto Turati starts out
with a lively and illuminating discussion on efficiency and equity in the
Italian Servizio Sanitario Nazionale over the last 30 years. He then dares to
look into its future and predicts that it will be shaped by the structural
tensions between the centre-north and south regions. Joan Costa-Font turns
his attention to the paradigmatic case of Spain, where decentralization is
linked to democratization and modernization. He cogently and eloquently
argues that although decentralization has succeeded in reducing regional
inequalities, soft budget constraints present a major challenge for the future.
Scott L. Greer masterfully discovers and rigorously explores the asymmetry
of territorial politics in the UK, which manifests itself in constitutional
decentralization on the one hand and policy centralization on the other. He
makes a strong case against decentralization being considered health policy
in its own right. Jon Magnussen and Pål E. Martinussen present a compre-
hensive account of the Norwegian healthcare system in the context of the
other Nordic countries. They expertly bring to the fore the contrasting
trends of centralization, decentralization and re-centralization over a long
time horizon.
The second part of the journey covers social insurance systems and takes
the reader from the east to the west of Europe. Katarzyna Kuć-Czajkowska
and Małgorzata Rabczewska lead an exemplary discussion on decentraliza-
tion in Poland in the context of post-communist democratization in Central
and Eastern Europe. They skilfully compile rich evidence showing how the
initial decentralization of ‘problems rather than resources’ led to the subse-
quent re-centralization of health policy-making. Birgit Trukeschitz, Ulrike
Schneider and Thomas Czypionka provide a lucid and impressively detailed
institutionalist analysis of federalism in the Austrian health and social care
system, discuss its performance and make important suggestions on how to
improve it. Margitta Mätzke offers an excellent study of health and social care
policy in Germany. She aptly focuses on the distributional tensions arising
from centralized policy-making and decentralized implementation, and then
boldly questions whether federalist institutions have become obsolete in
Europe’s oldest social insurance system.
The journey continues by following the historical diffusion of German
social insurance innovation westwards. David K. Jones dexterously investi-
gates the intricacies of French territorial politics through interviews with
officials at multiple levels within the newly created regional health agencies.
He pertinently places this reform into a historical perspective, scrutinizes its
likely impact on actual policy, and discusses obstacles to its successful imple-
mentation. Janet Laible produces a thorough and convincing analysis of the
impact of federalization on health policy interests and institutions in Belgium.
She compellingly demonstrates how nationalist and regionalist politicians
have politicized health policy, turning it into a contentious battleground in
constitutional reform. Berit C. Gerritzen and Gebhard Kirchgässner make a
major contribution to our understanding of the influence of federalism on
health and social care by critically examining the crucial case of Switzerland.
They adeptly highlight the leading role of cantons in the Swiss health system,
© 2014 John Wiley & Sons Ltd 111
S OCIAL P OLICY & A DMINISTRATION, VOL. 48, NO. 1, FEBRUARY 2014
Sarah Nettleton’s The Sociology of Health and Illness, now revised for a 3rd
edition, has long been a presence on many undergraduate reading lists. There
was a ten-year gap between publication of the first two editions, and the
second edition reflected the many developments which had taken place in
the field of medical sociology in that decade; this 3rd edition comes a
comparatively speedy five years later, and hence the differences between
the latter two editions are not as radical. The earlier editions were valued
for their rigorous and accessible overviews of the seemingly ever-growing
field and I have little doubt that this latest update will prove equally as
popular.
The introductory chapter begins by describing how our ideas of what
counts as health and illness have changed dramatically over the last 50 years.
No longer do we think solely in terms of hospitals, doctors and nurses, being
sick and being cured; health has become a ‘ubiquitous motif’ throughout our
life course and in our daily lives, with a plethora of magazines and TV
programmes telling us how to be healthier. The introductory chapter sets out
very clearly the breadth of topics which sit under the umbrella of sociology of
health and illness, from the formal institutions of medicine through to indi-
vidual responsibility via social context and lay knowledge. Having set out ‘to
communicate and encourage a critical and analytical approach to the study of
health, illness and disease’, the author then introduces the reader to the
difference between sociology of medicine and sociology in medicine, and sets
out the core approaches to the subject using Clive Seale’s organizational
device to show different ways of looking at the in/of dichotomy, and different
References
Bourdieu, P. et al. (1999), The Weight of the World, Palo Alto, CA: Stanford University
Press.
Fletcher, D. R. (2011), Welfare Reform, Jobcentre Plus and the street-level bureau-
cracy: towards inconsistent and discriminatory welfare for severely disadvantaged
groups? Social Policy & Society, 10, 4: 445–58.
Lipsky, M. (1980), Street-Level Bureaucracy: Dilemmas of the Individual in Public Services, New
York, NY: Russell Sage Foundation.
Meyers, M., Glaser, B. and MacDonald, K. (1998), On the front line of welfare
delivery: are workers implementing policy reforms? Journal of Policy Analysis and
Management, 17, 1: 1–22.
This is a useful study on policy transfer that reiterates for me the importance
of edited collections in social science. If one wants to get up to speed on policy
transfer and learning one could do worse than reading it from cover to cover.
Not that it is a simple encyclopaedic account of where we are in this field, but
rather contains a useful collection of studies from around the world. The
strength being that this rather diverse (in a good way) collection of studies is
united by tackling the issue of public policy through the lens of policy transfer;
so it ticks both boxes of being a reasonably interesting study of various policy
initiatives, and an investigation, theoretical or otherwise, of a current research
programme.
What is policy transfer? As the name suggests, it is more-or-less the transfer
of some aspect of policy – be it ideas, inspiration, design, instruments, outright
copying or whatever – from one jurisdiction to another. This can be between
countries, within different jurisdictions within a single country, and even
across time periods. There are other approaches which overlap or simply have
different labels – diffusion, learning, lesson drawing, harmonization – perhaps
adding to the sometime vagueness. However, a certain slipperiness at the
edges does not discount policy transfer as useful organizing principle;
although perhaps the seemingly interminable attempts, including by scholars
in this book, to further specify typologies that label each and every type, can
be somewhat tedious.
It is not a new idea by any means, despite claims otherwise. Students of
colonial history in particular have noted the importance of colonial heritage in
‘coercive’ transfer of law, agencies, constitutions and other agencies to new
regimes. There are attempts to tie aid to required policy positions. Policy
transfer can be voluntary, as part of a rational policy search for solutions; or
it can simply be a another item in the variegated, political and highly ideo-
logical tool box of policy-making, used to justify a myriad of policy changes or
simply to hide the fact that substantive policy change has not occurred.
Sometimes it is simply a new policy label or snatch of rhetoric that is trans-
ferred, and things continue much as before.
There are still many unanswered questions in the policy transfer literature.
What is a successful transfer? Successful for whom? Often, success seems to be
equated with the transfer of particular policy instruments – implementation
success perhaps. The study in Chapter 1 of Saudi Arabia and Georgia seems
to treat policy transfer success in this way as the adoption of some widely
accepted programme of ‘good governance’. Partial success only is achieved,
with both countries, and elites within those countries, resisting and adapting
reforms largely pushed from elsewhere. The study in Chapter 2 of govern-
ment performance initiatives between England, Scotland and Wales is
perhaps useful in the context of understanding this policy transfer ‘success’.
Constituent counties of Great Britain often have significant policy differences
perhaps less apparent to outsiders who confuse England with the rest of Great
Britain, and this chapter is useful is showing how nationalistic and political
factors shaped and channelled policy learning in different and sometime
divergent ways. Studies of Australia and South America show how policy
transfer is absorbed and channelled through path dependency and existing
institutions, and the interplay of interests and actors. Australia’s federal system
allows for experimentation on policy initiatives, perhaps leading to consider-
able divergence. Joining international organizations can assist in policy
harmonization/transfer as Chapter 6 notes, echoing studies on policy conver-
gence made elsewhere, while policy transfer is often a useful means for
‘catching-up’ sometimes through copying, as Chapter 4 on Estonia and Latvia
shows.
Chapter 5 is a particularly useful survey, showing how decentralization of
the Malawian health sector was resisted through bureaucratic self-interest and
institutional constraints. But it leaves unanswered questions. For some it was
a failure, but for some policy elites, adaption and resistance might well be a
‘success’. ‘Success’ is a social construction, and might depend on where one
stands. Was there evidence this programme would work in any event? Why
was it an answer to the problems Malawi was facing? If policy is transferred
‘successfully’ in a narrow sense of implementation success, does this lead to
better policy outcomes? How? As such, despite all the protestations otherwise,
I feel some policy transfer literature has not fully embraced notions that, at
heart, policy-making is seldom directed at rational problem solving, and
transfer is simply another aspect of the political, ideological and messy
garbage can which is government. It may also lead to worse policy outcomes.
However, the better chapters in this collection make a good attempt at
engaging with these issues, and so this book is a useful addition to the
literature.