Under the shadow of the state: Implementation, Regulation and Professions – the case of the community mental care reforms in Sweden and England
2008 (English)Conference paper (Refereed)
Why do similar policies adopted in different countries lead to different outcomes? One of the consequences of the public sector management reforms since the 1980s has been the realization the adoption of similar public sector reforms, often based on business models, did not lead to the same implementation strategies being adopted as assumed by the architects of NPM. There has been increasing interest among political scientists attempting to explain why similar reforms lead to different outputs and outcomes during the implementation phase and whether this signifies the existence of different national policy styles and national preferences for different methods and strategies to steer the implementation process resulting in national differences in implementation strategy.
One such reform where similar reforms led to different outcomes was the mental health, also known as community care, reforms adopted by Sweden and England in the mid 1990s. Both countries had similar reform objectives: firstly to disaggregate services by separating social care services from medical services; and secondly by decentralisation via the transfer of financial, administrative and service-provision responsibilities to local government social services departments for social care services. The transfer of responsibilities created new professional roles for social services staff where the largest profession is social work. However a decade later, the implementation of the reforms display divergent paths, with governments choosing different steering instruments. Sweden’s reform has focussed on indirect bottom up steering and softer implementation instruments; with most of the details of the reform’s implementation to be determined locally by local government, yet resulting in wide variations in service levels, quality and unclear accountability mechanisms. In England implementation reform was based on “top-down” steering and hard implementation instruments determined and controlled by the government, and linked with stringent performance management systems. Government strategy emphasised centralised inspection, objective setting and steering, resulting in the standardisation of outputs with accountability in terms of meeting government priorities and targets, rather than holding local politicians to account for local services. The paper identifies different reasons why governments to choose different steering strategies.
Place, publisher, year, edition, pages
professions, mental health, Britain, Sweden, implementation, public policy
Public Administration Studies
Research subject Political Science
IdentifiersURN: urn:nbn:se:uu:diva-163086OAI: oai:DiVA.org:uu-163086DiVA: diva2:462681
XV NOPSA conference in Tromsø
ProjectsDemokrati & deprofessionalisering