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The social health care policy implementation gap: moving beyond the legacies of 'new' public managementUniversity of Edinburgh How do social health care policies fare within economically rational structures? This paper, based on a study of two Scottish maternity units, identifies and explains a number of gaps in social health care policy implementation and practice. One finding suggests that devolved budgets result in a certain amount of operational fragmentation, increased attention to cost consciousness, low staffing levels and ultimately a noticeably decreased concern for social health care policy implementation. What can be done to ensure that health and welfare services are democratized? This paper proposes that moving beyond new public management involves an alternative model which would encompass a broadened form of economic regulation. Such a model would ensure that health and welfare outcomes are comprehensively accounted for in financial terms. There are strong indications that subjective service user indicators of health and welfare are just as important as objective professional assessments. Another indication is that whereas technological determinism sparks off rising costs, service user self-determination and self-management, which situates medical expertise at the periphery rather than the centre, could save public money. Thus, the need to widen the economic base serves both the objectives of the treasury and the needs of the public.
Public Policy and Administration, Vol. 21, No. 4,
42-59 (2006) |
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