Continuity and Change in Public Policy and Management
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Continuity and Change in Public Policy and Management

Christopher Pollitt and Geert Bouckaert

Combining theory development, international comparison and original case study analysis, two of Europe’s leading public policy and management scholars apply and develop some of the main models of policy change and offer a revealing long-term view of policy developments since 1965. Drawing on an extensive programme of elite interviews and documentary analysis they provide an integrated treatment of national and local policymaking in two major public services – hospital care and the police – in England and Belgium. This timely book addresses the ‘paradigm wars’ in public policy, arguing for a nuanced intermediate position that challenges the orthodox and the post-modernists alike.
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Chapter 6: What Happened Locally? Hospitals

Christopher Pollitt and Geert Bouckaert


INTRODUCTION In the previous chapter we experienced a first encounter with some of the (many) broad quantitative indicators of policy inputs, processes, outputs and outcomes. In doing so we were obliged to face up to the complexities and ambiguities of linkages between what policymakers say, what they do, and what eventually happens, ‘out there’, ‘in the field’. In this chapter (and the next) we move closer to that ‘field’. We look at what happens when national polices ‘hit the ground’ locally. Are they enthusiastically embraced, reluctantly accepted and implemented, creatively interpreted, astutely deflected, diluted, delayed, resisted or even ignored? And how far do national policies dominate the local agenda anyway? Are there also significant locally generated polices, particular to the place (as one would expect in a genuinely multilevel system)? How do local and national agendas interact? To create this local perspective, we conducted research in two cities: Brighton and Hove (southern England) and Leuven (just east of Brussels, in the Vlaams Brabant – Flemish Brabant – region). As we said in Chapter 1, we chose these as two reasonably prosperous, reasonably cosmopolitan, middle-sized cities which were not burdened with any major handicaps such as the collapse of local industries, geographical remoteness or high levels of ethnic tension and division. (For details of the research, see Appendix). Brighton was, with neighbouring Hove, jointly designated a ‘city’ (rather than just a town) in 2000. Together they have a population of roughly 250 000. On the south coast, and backed by areas of beautiful...

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