The core of this paper is a case study of how a District Health Authority (Paddington and North Kensington, now Parkside DHA following a recent merger with Brent DHA) in Inner London responded to a major new health care issue of the 1980s—Aids, but the paper also seeks to locate this case study material within wider debates. What theories are there of organisational change which could be used to illuminate policy and service change in the health care sector? How, indeed, do we best study change in health care organisations? The paper is thus in three parts. In the first section we identify some streams of literature which act as a frame of reference defining our initial research question and discuss implications for methodology. The second section presents the case itself, while the last section discusses some emerging findings.

While pioneering has long been assumed to be the unique function of voluntary agencies, the flow of private invention to public adoption has rarely been studied empirically. Drawing on an exploratory study of twenty national agencies serving the physically and mentally handicapped, this article re-evaluates the vanguard role of the voluntary agency. Much of what has been regarded as ‘innovative’ consisted of small-scale, non-controversial, incremental improvements or extensions of programs with few original features to under-served clienteles. A series of external and internal organizational constraints to the statutory adoption of new programs is identified, which suggests that the conventional notion of voluntary pioneering is no longer appropriate. A new model of program change is proposed based on multiple outcomes and a redefinition of the concept of innovation. Some hypotheses are offered regarding conditions conducive to the initiation of new programs.

Noting limited attention by international development agencies to inequalities compared to global poverty, we ask how these two challenges have been framed in agencies’ policy publications during the past several decades. Following a recent application of algorithmic analysis to health policy narratives in the UK, we use text-mining software to compare the frequency of two alternative conceptualisations of poverty and inequality in three different document categories: the World Bank's World Development Reports, the United Nations Development Programme's (UNDP) Human Development Reports and a set of white papers by bilateral donor agencies. In a second step, we visualise each document's degree of contextual similarity in using the two conceptualisations of poverty and inequality with all documents in the same source category. We find that while references to poverty have, on average, been twice as prominent as references to inequality, conceptualisations of poverty and inequality as well as the textual contexts in which they appear differ both temporally and substantively between agencies included in our sample. We show how such agency-specific framing patterns can be leveraged politically to forge more effective social policy coalitions. We also outline follow-up research capable of capturing the politics of language underpinning our observations.

This study examines what motivates an organization representing a religious-national minority to provide social services. The case study for examining this issue is the Islamic Movement in Palestinian society in Israel, and specifically its social activities in the town of Kafr Qassim. The article analyzes the factors leading to the development of the movement’s various services in the town by tracing their historical development and current offerings. This case study analysis is informed by two theoretical bodies of knowledge: the development of NGOs and the development of faith-based organizations. The data is based upon 17 semi-structured in-depth interviews with the heads of all the social services, social activists and municipality representatives in Kafr Qassim, where the movement was established. Some of the interviews also include tours and observations of actual services provision. Additional sources include archival documents, such as the organization’s regulations and work plans. The findings identify three main factors in the development of minority religious organizations: government failure in providing services (necessary factor) and religious ideology and mobilization of political support as secondary factors. All three are grounded in the ongoing conflict between the Palestinian minority group and the state.

A major reason for the gendered division of parental leave use is the financial compensation during leave. Swedish national parental leave benefit provides 77.6 percent of earlier earnings up to an income ceiling, but collective agreements cover part of the income loss above the ceiling during leave. We focus on the importance of such collective agreements by examining fathers’ parental leave take-up across the 2000s, as agreements were expanded during this period in time. We combine register data for the period 2001 to 2011 with the Longitudinal Integrated Database for Health Insurance and Labour Market Studies (LISA) being the key data source. The main division of agreements is between the state, the municipality and county, and the private sector. Results indicate that fathers with income above the income ceiling increase their use over the time period. Especially in the private sector a polarisation can be seen, where high income fathers increase their leave use, while fathers with lower income fall behind. As we do not find stronger increase in fathers’ leave use in sectors where agreements expanded across time there is no evident support of a direct effect of the top-ups.

The welfare state is but the vehicle for the provision of welfare and the latter does not necessarily entail the former. Much recent debate occasioned by government policy and rhetoric has therefore confused means and ends. This paper argues that a defence of welfare must come before a concern for protecting the welfare state. A number of foundations for guaranteed welfare provision, including justice, rights and contract are considered but the most persuasive foundation for welfare as need-meeting is found to lie in the Kantian categorical imperatives. Not only do these provide a moral prescription that welfare ought to be provided, they also dictate the ways in which it ought to be provided. It is against these requirements therefore that the necessity of a welfare state as a means of providing welfare can be tested. The second part of the paper then considers how extensive a welfare state needs to be, and how the boundaries between the public and private domains in the provision of welfare may be drawn. The equality principle, allied to the notion of equality of welfare, is found to be a useful instrument in determining the bounds of the public domain but only (so the paper concludes reluctantly) when harnessed to objective specifications of need.

The social security structure has been seen as a serious disincentive to the employment of women married to unemployed men. The implied significance of this disincentive is not apparent from verbal accounts, where only a minority of such women cite social security considerations as having any direct relevance in their own labour force experience. Recent research, critical of the social security model, has been conducted with a view to exploring the employment strategies of couples. In such research, economic structure is seen as the context of household employment strategies but not, it appears, as part of their substance; household level processes and ‘external’ economic processes are separated. In this respect, such approaches parallel the social security model. The present paper is based on an analysis of the household circumstances and employment histories of 790 couples in Hartlepool. Our findings suggest that ‘strategies’ regarding household income maintenance are patterned in relation to labour demand and occupational opportunity. This association contributes to the coincidence of spouses' employment status and is indicative of the problems of separating employment demand and labour supply processes, a separation which leads the social policy literature to overstate the significance of social security disincentives to employment.

The marketisation of European home care has given rise to significant private for-profit providers growth. However, little research has focused directly on commercial companies to examine the mechanisms through which they emerge, grow and shape long-term care policy – this is this paper’s task. Drawing on the literature on business power, the recent concept of “institutional business power” is introduced, defined as the power flowing from the entrenched position of business actors in the provision of public social services. The paper identifies the mechanisms through which private providers have grown and assesses the extent of their institutional power by examining their influence on policy and the support they obtain from relevant home care stakeholders. The limits of providers’ institutional power are also discussed. The paper relies on semi-structured interviews with representatives of public, private and non-profit home care providers.

Issues such as caring and family policy have received increased attention within the sociological literature on the welfare state during the past decades. At the same time, there has been much debate about the protection of social risks. In particular, scholars have questioned the ability of welfare states to respond to so-called new social risks, such as reconciling work and care. The literature on new social risks assumes welfare states will have difficulty addressing these risks due to pressures for reform and assumed individual responsibility for new social risks. In contrast, the Dutch welfare state has been successful in re-orienting existing institutions to develop a semi-collectivised yet market-driven form of childcare policy. Using qualitative interview data and document analysis, this article analyses the development of Dutch childcare policy from 1995 to 2009. The development of childcare policy is attributed to three social mechanisms: a common perception among actors viewing childcare as a solution to improve women's employment; a party politics mechanism, which creates a distinct Dutch approach to childcare; and a corporatist mechanism, referring to the interaction between the state and industrial relations, which failed in the area of childcare policy. The development of childcare policy has not been wholly unproblematic, however, and therefore a critical discussion of these developments is offered. Also, an update of policy developments through to 2013 is provided.

The role of means-testing within social policy has become more important and more central in the 1990s. However, extensive reliance on means-testing brings with it the accompanying problems of the unemployment and poverty traps. In the 1990s these take on more of the form of a poverty plateau, accentuated by a new savings trap. This article uses hypothetical calculations of benefit entitlement in order to explore the extent of the poverty plateau, and looks in particular at the impact on this of the growing use of means-tested rebates by local authorities. Means-tested rebates have been developed by authorities because of a concern that the new charges for services that they are making might disadvantage poor local citizens. Drawing on work of one typical authority, this article reveals that these rebates do add significantly to the poverty plateau, and yet that this is an issue which is little understood by both local and national policy planners.

Austerity is frequently associated with crisis-enabled spending cuts. What happens when the crisis is over? This article’s original contribution lies in its in-depth exploration of one mechanism that help explain austerity’s endurance post-crisis, when state elites face increased popular resistance and pressure to reinstate social spending. This mechanism calls attention to the role of economists in Central Budgeting Offices as agents of technocratization and de-politicization within social policy domains. These economists may institute an austere spending mode by changing social spending’s norms and instruments. To demonstrate economists’ role in mediating macroeconomic fiscal goals and social policy design over time, the article examines the development of child welfare policy in Israel before, during and in the aftermath of economic crisis. In this case, austerity attained hegemony when economists were able to delegitimize and shelve an ‘irresponsible’ social spending proposal – and in response to post-crisis demands for compensation – introduce an austere policy instrument to cap social spending during a period of social policy expansion. This analysis suggests that scholars regard relations between austerity and social spending as dialectical.

Research into public policy and public opinion demonstrates ample evidence that opinion affects policy, but relatively limited empirical findings regarding how policy might affect opinion: a process dubbed policy feedback. Much of the literature examines aggregate reactions to policy, while related public opinion research emphasises individual findings driven primarily by party affiliation or political ideology. This article takes the research one step further, examining whether individuals' judgements of policy effectiveness contribute to their support for or opposition to government policy spending. Specifically, it examines the case of US welfare reform and public reactions to it using a national survey conducted in 2001. Findings based on multinomial logistic regression analysis demonstrate not only that people's judgements of welfare reform's effectiveness contribute to their support for government spending on the poor, but also that the reasons behind their judgements matter.

This paper discusses issues raised by the uneven expansion of private health care in Britain in recent years. The problems being experienced by the industry have exposed divisions in the private health care industry and have provoked criticisms of the Government and requests for a greater degree of state support for, and regulation of, the industry. The paper therefore examines the scope for changes of government policy to facilitate further expansion. It argues that few of the alternatives are either technically adequate, in terms of solving the private sector's problems, or politically feasible, in the sense of being electorally justifiable. It concludes that policies to further private sector expansion could be implemented only at the cost of the private sector's independence, or at the expense of the Government's commitment to the NHS.

A number of circumstances have combined in the reform era in China to put women at a more disadvantageous position now than at any other time since 1949. Some of them reflect age-old prejudices, others are the result of the economic reforms, but the two join in a synthesis to threaten women's improved status. Health factors that have particularly impinged on women include: the one-child policy and the skewed birth ratio in favour of boys that this has led to; very clear problems in the area of mental health, including a suicide rate which is much higher for women than for men; kidnapping; and life-threatening exploitation in the new special economic zones. The government's desire to control women's fertility, however, has led to a marked improvement and increase in maternity and childcare health services in the last ten years. The central government has lost power to the provinces and is no longer able to take decisive action to protect women from the effects of discrimination.

This paper takes as its subject the explanation of social policy development through the use of comparative data. It is based upon the book by Piven and Cloward entitled Regulating the Poor, published in 1972. This book has been both dismissed too lightly and adopted too uncritically. While the thesis of the book may be somewhat over-simplified it nevertheless points to a range of important issues in social policy and exposes a number of assumptions. As well as evaluating Piven's and Cloward's general perspective this paper looks, in particular, at three themes. These are the relationship between social policy and social control, the relationship between work and welfare and lastly the relationship between power and poverty.

This article briefly reviews American and British literature on welfare dynamics and examines the concepts of welfare dependency and ‘dependency culture’ with particular reference to lone parents. Using UK benefit data sets, the welfare dynamics of lone mothers are examined to explore the extent to which they inform the debates. Evidence from Housing Benefits data show that even over a relatively short time period, there is significant turnover in the benefits-dependent lone parent population with movement in and out of income support as well as movement into other family structures. Younger lone parents and owner-occupiers tend to leave the data set while older lone parents and council tenants are most likely to stay. Some owner-occupier lone parents may be relatively well off and on income support for a relatively short time between separation and a financial settlement being reached. They may also represent a more highly educated and highly skilled group with easier access to the labour market than renters. Any policy moves paralleling those in the United States to time limit benefit will disproportionately affect older lone parents.

Outcomes Based Commissioning (OBC) – for example, Pay for Success (in the US) or Payment by Results (in the UK) – has been suggested as a way to provide ‘more’ social services for ‘less’ public resources. Such commissioning is often linked with an innovative financing tool called a Social Impact Bond (SIB). Using data from the Social Finance UK Database and focusing on SIBs in the US and UK, we evaluate whether the SIB approach aligns with the theoretical predictions of social innovation. The results provide limited evidence that SIBs facilitate capital injections from the private sector into the production of social goods as well as facilitate parts of the process of social innovation – namely, piloting and scaling. We conclude that there is significant variation, both between the US and UK and within the US, in social innovation ecosystems and the role played by SIBs.