Health and well-being

Should governments use the stick on vaccine refusers?

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Attwell NavinKatie Attwell & Mark Navin

What should governments do to people who don’t want to vaccinate? This question is especially pressing in the age of COVID-19, as policymakers face challenging questions about whether to exclude committed vaccine refusers from their jobs or public spaces. But this issue, like so many others during the pandemic, is highly contingent and uncertain: policymakers are implementing responses to vaccine refusal without being confident about the consequences of their policies. Continue reading →

Analysis of the dynamics of international food regulation in China

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May ChuMay Chu

Political scientists have been debating the question of whether global factors promote convergence, divergence or stability in regulatory policies and outcomes. In the age of a hyper-connected world, it is natural to conjecture that, for food safety regulations, countries would adopt international regulation and regulatory practices, in order to promote trade and expand income sources.

However, the debate risks over-simplification if the discussion stops at this point. National interests are multifaceted, meaning that government agencies cannot be guided by one set of interests only. The developmental needs of various sectors cannot be tackled by one approach. To build on existing theories of regulation, I explore the dynamics of China’s food safety regulation in practice, which has implications for this widely debated question. Continue reading →

How minimum unit pricing for alcohol almost happened in England and what this says about the political dynamic of the UK

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hawkinsBenjamin Hawkins

The UK Government’s Alcohol Strategy (GAS), published in March 2012, unexpectedly included a commitment to introduce minimum unit pricing (MUP) for alcohol in England, following the adoption of similar measures by the Scottish Government. Yet just 16 months later, the introduction of MUP was placed on hold indefinitely. Our recent article published in Policy and Politics seeks to explain how and why MUP came so unexpectedly onto the policy agenda in England, before disappearing just as suddenly, and what this tells us about the evolving political dynamics of post-devolution and post-Brexit Britain.

In Scotland, MUP passed into law at the second attempt in 2012 and came into force in 2018 following a six-year legal battle with the Scotch Whisky Association and other industry actors. The emergence of MUP as a viable policy option was, however, a ‘cross-border’ process with developments in Scotland inextricably linked to those ‘down South’, particularly the support for, and background work on, alcohol pricing within the Department of Health. Following its adoption in Scotland, a ’policy window’ opening in which MUP came onto the policy agenda in England also. However, this proved to be short lived. Our article argues that the success of MUP in Scotland and its failure in England can largely be explained in terms of the differing levels of political commitment to the policy in each context. Continue reading →

Virtual issue on Evidence in policymaking and the role of experts

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Sarah BrownSarah Brown,
Journal Manager, Policy & Politics

New virtual issues from Policy & Politics:
Evidence in policymaking and the role of experts

The importance of using evidence in policymaking and debates over the role of experts has never been more crucial than during the current coronavirus pandemic and ensuing public health crisis. From prevailing, long-standing debates over both topics in Policy & Politics, we bring you a collection of our best and most recent articles.

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Policy & Politics authors call for a moratorium on the use of management consultants in the NHS until effective governance is established

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IanKirkpatricketalIan Kirkpatrick, Andrew Sturdy, and Gianluca Veronesi

A recent study on the impact of management consultants on public service efficiency, published in Policy & Politics, prompted this letter from the authors calling for a moratorium on their use until effective governance is established.

 

Open letter to the Rt Hon Jeremy Hunt MP, Secretary of State for Health and Social Care

 2nd July, 2018

Dear Mr Hunt,

Re Calling for a moratorium on the use of external management consultants in the NHS until effective governance is established

We recently conducted independent research on the use of external management consultants in the NHS in England. This was subjected to peer review to establish the rigour of its analysis and published in an academic journal (Policy & Politics). Since then, it was mentioned in a parliamentary debate (23rd April, 2018, Hansard Volume 639) and widely reported in the media (21st February, 2018), including in The Times, which has also seen this letter.  Continue reading →

Using management consultancy brings inefficiency to the NHS

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IanKirkpatricketalIan Kirkpatrick, Andrew Sturdy, and Gianluca Veronesi

Few topics have provoked as much debate and controversy in many western societies as the growth in public spending on management consultants. In the UK’s public healthcare sector: the National Health Service (NHS), this spending more than doubled from £313 million in 2010 to £640 million in 2014. Understandably, it is under constant scrutiny and there are considerable pressures to cut the use of management consultants, but spending remains high. Management consultants provide advice on strategy, organisation, financial planning and assist with the implementation of new information technology. Frequently, they promise significant improvements in efficiency. According to the main industry body in the UK, the Management Consultancies Association (MCA), for every £1 spent on consulting fees, clients can expect £6 in return. However, as shown in a study we conducted recently, published in Policy & Politics, the use of management consultancy in English NHS hospital trusts is more likely to result in inefficiency.

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The modern welfare state in transition: framing new co-production roles and competences for public professionals

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Nederhand-van MeerkerkBy José Nederhand and Ingmar van Meerkerk

“The place where we organize care, how we provide care, and those who provide the care will change” – Dutch Ministry of Care (2013), Vision on Care and the Welfare Labour Market.

The Dutch Ministry of Health has announced extensive reorganization of the care system. Just like in many other Western countries with ageing populations, the welfare state is subject to major reforms. In parallel with academic debates, the idea of co-producing and self-organizing public services seems to have penetrated the discourse of politicians and governors all over the world. Politicians state that in order to keep care provision affordable, accessible and in line with societal demands, responsibilities should be shifted ‘back’ to society. Through volunteering, citizens are expected to shoulder tasks formerly performed by the state, either by partnering and co-production with the state or by self-organization. Our systematic content analysis shows that citizens are now generally framed as active service producers which are, and should be, part of the general system of care service delivery. This activation of citizens has considerable implications for the roles, competences and responsibilities of care professionals. In fact, government is calling for a new public service ethos of professionals, see our recent article in Policy and Politics. Continue reading →

A pathway to precarity? Young workers and zero hour futures in the social care sector

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Montgomery-Mazzei-Baglioni-SinclairTom Montgomery, Micaela Mazzei, Simone Baglioni, Stephen Sinclair

In an effort to solve crucial issues such as youth unemployment, policymakers can find it tempting when it looks like there is an opportunity to kill two birds with one stone. When you have a population living longer and requiring personal care for many years to come it can seem logical that there is a future in that sector for a generation of young workers. However there is a risk that the prospect of new potential employment for young people eclipses an awareness of the quality of work available in that sector.

Our recent article in Policy & Politics entitled Who Cares? The social care sector and the future of youth unemployment explores the actual potential of the social care sector in the UK to offer good quality career pathways for young people. Continue reading →

Vodcast to promote article: Relational Wellbeing: Re-centring the Politics of Happiness, Policy and the Self

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Take a look at this short video by Professor Sarah White, Professor of International Development and Wellbeing at the University of Bath, who talks about her research, published in Policy & Politics, on why all the interest and talk of our wellbeing may reflect an anxiety that all may somehow not be well…

 

If you enjoyed this blog post, you may also like to read Policy, politics, health and housing in the UK by Danny Dorling.

Is universal health coverage possible without strong public presence in its provision?

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volkan-yilmaz-jpgVolkan Yilmaz, Assistant Professor of Social Policy at Boğaziçi University, Turkey

As part of the Sustainable Development Goals, a United Nations (UN) initiative covering a broad range of development issues, all members of the UN set an ambitious and greatly welcomed target to be achieved in healthcare policy by 2030: achieving universal health coverage. The World Health Organisation (WHO) defines universal health coverage as a set of policies ensuring everyone in need of healthcare services and medications receive a quality service yet without facing financial hardship. This notion of universal health coverage leaves no room for denying services and medications to people in need.

However, as is often the case, the devil is in the detail. As far as indicators for monitoring progress towards universal health coverage are concerned, it turns out that this is a broken promise. Two indicators are in use: the share of population that can access ‘essential’ healthcare services and the share of population that spends a large amount of its income on healthcare. The second indicator is estimated on the basis of households having to spend a disproportionate amount of their total income on health, measured as 25 per cent or more of their total household expenditure.

The first indicator in particular seriously limits the scope of universal health coverage by leaving out healthcare services that are not defined as essential. For example, while cervical cancer screening is listed among essential services, cervical cancer treatment is not. The second indicator may help by putting an upper limit on the proportion of total household expenditure to be spent on non-essential health services, but it may still fail to capture how many people don’t seek medical help for these services.

Dr Margaret Chan, Director General of World Health Organization, clearly suggests that free markets do not work in health care. Chan’s emphasis is on the financing component. Specifically, if public funding of healthcare is weak, achieving universal health coverage is generally not possible. Therefore, she identifies increasing public expenditure on healthcare as the only way towards universal health coverage, which will result in less reliance on out-of-pocket payments.

But healthcare systems have two major components that are of importance in achieving universal health coverage: financing and provision. To achieve universal health coverage, while public funding of healthcare is key, exclusive focus on the financing component in ensuring universal health coverage might be misleading. I believe the significant role that the public sector can play in healthcare provision – and has already been playing in some countries – has been long overlooked. Failing to pay enough attention to the role of the public sector in healthcare provision can pose two obstacles in monitoring progress towards universal health coverage.

First, this focus may blind us to how the dominant role of private sector or privatisation trends in healthcare provision restrict access to healthcare services that are deemed non-essential. On the one hand, exclusive focus on essential health services may be interpreted as rationing, which is indeed necessary for all public policies due to budget constraints. On the other hand, the restrictive definition of essential health services may go beyond rationing especially for middle income and upper middle income countries with historically strong public provision systems. This restriction of the scope of universal health coverage to essential services may take the form of people’s aversion to seek medical help due to financial hardship and/or increasing expenditures on health as a proportion of total household incomes. In this regard, the proposed strategy of WHO to achieve universal health coverage may be implicitly granting approval to the privatisation of non-essential health services in countries with strong public actors in provision.

Second, this disregard for the ownership of providers in healthcare leaves out the possible impact of private sector dominance on provision in healthcare financing. Not all market designs foster competition and lead to lower prices for services. Not all countries have strong public regulatory capacity to protect patients from possible abusive practices of private providers. Finally, not all political actors in power are willing and strong enough to block private providers’ demand for higher out-of-pocket payments and/or switch to private health insurance based financing models. Concerning these, WHO’s strategy falls short of addressing these concerns which may well affect the prospect or viability of universal health coverage in different countries.

My forthcoming book entitled The Politics of Healthcare in Turkey demonstrates that despite significant achievements towards universal health coverage in Turkey in the last decade, a country that Dr Chan also lists among best performers, striking the right balance between public sector and private sector in healthcare provision remains a challenge for Turkey. Passive privatisation in healthcare provision and the political dynamics it has generated, cast doubt on viability of universal health coverage.

Setting a target for all countries is not easy, especially given the vast differences among them and the presence of strong global interest groups against reforms towards universal health coverage. But these challenges should not lead us to settle for a narrowly defined version of universal health coverage as a global policy direction for all countries. I suggest therefore that the lack of focus on the provision component of healthcare systems in the global health policy debate must be re-thought, especially if we want to reclaim the proper meaning of universal health coverage.

If you enjoyed this blog post, you may also like to read When collaborative governance scales up: lessons from global public health about compound collaboration by Chris Ansell.