Arm's Length Bodies Research Articles

Citizen satisfaction with arm's length bodies in local government: expert insights on policy and practice

PurposeThe purpose of this study is to investigate the application of citizen satisfaction (CS) as a tool for measuring performance by arm's length bodies (ALBs) in local governments across eleven countries, addressing central questions about its functionality and influencing factors.Design/methodology/approachWe employ a hybrid inductive-deductive explorative study design, characterized by an iterative interpretative approach guided by sensitizing concepts. Expert interviews are analyzed through template analysis and cover eleven countries where ALBs are present due to decentralization and outsourcing.FindingsOur study uncovers limited real-world applications of CS in evaluating public service delivery by ALBs. Expert interviews reveal insights into factors potentially influencing CS use, such as the level of autonomy of local governments, state traditions and austerity measures. A research agenda is formulated for further investigation.Originality/valueContributing to the CS debate, our study focuses on its application in evaluating public service delivery by ALBs. The explorative design, expert opinions and theoretical foundations enhance understanding, offering insights into factors potentially shaping CS use in this context. The study proposes a research agenda, propelling further investigations into this underexplored, yet emerging, area.

The Health Services Safety Investigations Body (HSSIB) and safety management systems: An integrated approach to managing safety in healthcare

The Health Services Safety Investigations Body (HSSIB) was established by the Health and Care Act 2022 as a new non-departmental arm's length body, replacing the former Healthcare Safety Investigation Branch. HSSIB exists to help reduce patient harm by understanding the complex interactions that exist within healthcare that may lead to patient safety events occurring. In other safety critical industries, a safety management system (SMS) approach is used to help enable proactive assessments of risks, specification of how risks should be managed, and set clear lines of accountability and responsibility in addressing risks. HSSIB has begun to explore how an SMS may operate in healthcare to help better equip the system to identify, respond, and proactively identify emerging and recurring concerns that may impact on the safety of patients.

'Not in it for huge profits but because it's right': The contested moral economies of UK-India exports in health worker education and training.

While the growth of global markets in health-related services may have significant consequences for healthcare provisioning and training, it has received relatively little attention from the social sciences. This article examines UK-India, and specifically England-India, exports in health worker education and training as one such global market, drawing on sociological scholarship on moral economies to understand how trading in this field is constructed and legitimated by the individuals and organisations involved, what tensions evolve, and what is at stake in them. We employ a qualitative mixed methods approach using publicly available materials on existing UK-India collaborations and primary data from interviews with key stakeholders in India and the UK, including government departments, arms-length bodies, NHS Trusts, trade associations and private providers. Our analysis illustrates the key discursive strategies used to legitimate engagement in these markets, and the complex and contested moral economies unfolding between and across these stakeholders and contexts. Not least, we demonstrate the conflicting moral sentiments and the boundary work required to realise commodification. Situating cross-border trade in health worker education and training in a moral economy framework thus illuminates the social context and moral worlds in which this evolving trade is embedded.

UK cancer healthcare professionals collaborating with colleagues in low- and middle-income counties: Mapping the extent and nature of partnerships.

e18512 Background: Most cancer deaths occur in low- & middle-income countries (LMICs). In 2020, the UK Global Cancer Network (UKGCN) formed to unite those interested in Global Oncology & to strengthen collaborative work with colleagues in LMICs to reduce morbidity & mortality from cancer. For the first time in the UK, the UKGCN undertook a mapping exercise, to document the number & type of collaborations between the UK & LMIC partners. Methods: A semi-structured survey was developed & performed over 10 weeks from February 2021, to identify UK individuals & institutions engaged in clinical practice, research &/or education with LMIC partners, where the aim was to improve the care of people with/at risk of cancer. The survey was emailed to individuals in NHS hospitals, charities, universities, other organisations, UKGCN members & to contacts identified by a literature search. Results: A total of 639 invitations were sent & 88 responses received. Results demonstrate a range of collaborative efforts spanning many areas of cancer control:health promotion & prevention, diagnosis & treatment to survivorship & palliative care. A wide range of countries were represented: Sub-Saharan Africa, South America, MENA region, China & South-East Asia. Projects included education & training (146), clinical practice (144) & research (226; Table). Funding sources for projects included academic institutions, private sector, United Nations agencies, UK government, arms-length bodies & international government. Conclusions: This mapping exercise has demonstrated considerable UK collaboration with colleagues in LMICs across the continuum, involving all 3 domains of education, practice, & research. This mapping exercise will serve as a baseline on which to build a more accurate database to measure future work. It will enable the UK community to guide domestic strategy, increase efficiency, enable innovation & accelerate collaborations. Information from the survey has been used as a catalyst to create new partnerships between colleagues working in similar geographical settings, encouraging bidirectional learning leading to mutual benefit. Next steps include using this data to support calls for increased funding in global cancer care, & for institutional recognition of, & investment in, Global Oncology as a discipline. The survey will be repeated using more comprehensive methods to increase accuracy with a view to maintaining an up-to-date database.[Table: see text]

COVID-19 vaccination decisions among Gypsy, Roma, and Traveller communities: A qualitative study moving beyond “vaccine hesitancy”

BackgroundMany people refuse vaccination and it is important to understand why. Here we explore the experiences of individuals from Gypsy, Roma, and Traveller groups in England to understand how and why they decided to take up or to avoid COVID-19 vaccinations. MethodsWe used a participatory, qualitative design, including wide consultations, in-depth interviews with 45 individuals from Gypsy, Roma, and Traveller, communities (32 female, 13 male), dialogue sessions, and observations, in five locations across England between October 2021 and February 2022. FindingsVaccination decisions overall were affected by distrust of health services and government, which stemmed from prior discrimination and barriers to healthcare which persisted or worsened during the pandemic. We found the situation was not adequately characterised by the standard concept of “vaccine hesitancy”. Most participants had received at least one COVID-19 vaccine dose, usually motivated by concerns for their own and others’ health. However, many participants felt coerced into vaccination by medical professionals, employers, and government messaging. Some worried about vaccine safety, for example possible impacts on fertility. Their concerns were inadequately addressed or even dismissed by healthcare staff. InterpretationA standard "vaccine hesitancy" model is of limited use in understanding vaccine uptake in these populations, where authorities and health services have been experienced as untrustworthy in the past (with little improvement during the pandemic). Providing more information may improve vaccine uptake somewhat; however, improved trustworthiness of health services for GRT communities is essential to increase vaccine coverage. FundingThis paper reports on independent research commissioned and funded by the National Institute for Health Research (NIHR) Policy Research Programme. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care or its arm's length bodies, and other Government Departments.

A changing view on patient safety: how the Healthcare Safety Investigation Branch has brought system-focused investigations to the fore

In this perspective, the chair designate of the Healthcare Services Safety Investigation Body (HSSIB), the new arm's length body transitioning from the Healthcare Safety Investigation Branch (HSIB), reflects on how the Francis Inquiry was instrumental in changing the view of patient safety in the NHS, the role of HSIB over the last 5 years in identifying systemic causes of patient harm and what the future holds for HSSIB.

Areas of research interest: joining the dots between government and research at last?

Background: With the aim of making it easier for researchers to produce policy-relevant research, the UK Government now requires all departments and arms-length bodies to publish annually-updated statements of their evidence needs, called ‘Areas of Research Interest’ (ARIs). We describe how ARIs are produced, and how they are used to support this aim. Aims and objectives: In this paper we offer a description of ARIs and their development by UK governmental departments, and an assessment of how different stakeholders, including academia and funders, have responded to or otherwise used the ARIs. Key conclusions: ARIs are a mechanism for organisations to share their research interests with external audiences in the form of a published document. In addition to this primary aim, they also have a much broader set of uses, including connecting departments with each other and helping intermediaries shape engagement plans. All groups would benefit from more robust evidence to choose effective engagement mechanisms, and more can be done to make the ARIs discoverable and useable. Overall, the ARIs are a useful tool to illuminate, and begin to connect different parts of the research-policy system.

7.C. Workshop: Towards a true European Health Union: milestones, drivers and barriers

Abstract European health system responses to the COVID-19 pandemic have also demonstrated that European integration in health and health systems add value beyond what individual Member States can do: ranging from the joint purchase of medicines to providing large budgets for building back better. With a true European Health Union we will strengthen our health systems beyond crisis preparedness and response, which is necessary as we are facing the evolving perma-crisis, We will need to strengthen our health systems in general always with a view to Universal Health Coverage and improving health system performance. The European Health Union can work to help strengthen health systems, which may include support for Member States research, learning from best practices, investment but also common solutions including new or extended EU mandates, new arms-length bodies, as well as more coordination or harmonization. It has also taught us that we cannot wait to strengthen our health systems as we are in Europe in a perma-crisis. The panel will address the following questions: • Where are we with our progress towards a true European Health Union? • What policy change is needed to create a true European Health Union? • What would be the role of the true European Health Union strengthening and supporting Member States? We will zoom in on the 1) existing public health mandate of the EU, 2) the impact of other EU-policies on health and health systems, 3) the new economic governance and, 4) the role of the EU in global public health Key messages • A true European Health Union will strengthen universal health coverage and health system performance. • A true European Health Union goes beyond crisis-preparedness and respons. Speakers/Panellists Scott Greer University of Michigan, European Observatory on Health Systems and Policies, Ann Arbor, USA Anniek de Ruijter University of Amsterdam, Amsterdam, Netherlands Eleanor Brooks University of Edinburgh, Edinburgh, UK Thibaud Deruelle University of Lausanne, Lausanne, Switzerland

Impacts of joint municipal agencification on the democratic governance of waste management

PurposeThe study examines how introducing joint municipal arm's length bodies (ALBs) into municipal waste management has influenced the preconditions of democratic governance.Design/methodology/approachThe authors describe and explain the democratic implications of joint municipal agencification by reviewing the perspectives of representative and participative democracy. Through this approach, the authors apply the exit–voice framework developed by Albert Hirschman to highlight the potential roles and rights of citizens. This research includes country case studies of Finland and Norway. The authors analyse and systematize Finnish and Norwegian waste and organizational policies by reviewing national regulatory documents, commentaries and guidance materials to identify the fundamental missions and institutional traditions of the alternative organizational forms of joint ALBs.FindingsThe study findings highlight that joint agencification has an adverse effect on the democratic governance of waste management policy and services even though these are public monopoly services. They also demonstrate that all joint municipal ALBs limit the classic elements of representative democracy in general, and that private-law ALBs limit residents' rights to influence and participate.Originality/valueThis study contributes to local public management studies by applying Hirschman's theory to comparative reviews of joint agencification and ALBs. It revealed the similarities and differences between the different organizational forms of joint ALBs applied in Finland and Norway. It also demonstrated how the democratic rights of residents depend on how municipalities collaborate.

Allied health professions public health research priorities: A modified e-delphi study in the United Kingdom

ObjectivesThis study identifies the United Kingdom (UK) Allied Health Professions (AHP) public health research priorities through a modified e-Delphi study conducted with an expert panel. Study designA modified e-Delphi study was utilised in this study. MethodsThis study used a modified e-Delphi approach to reach a consensus on research priorities. Expert panel members were invited to participate and complete three rounds of the e-Delphi. Ethical approval was obtained through the Public Health England Research and Evidence Governance Group. ResultsA total of 38 participants completed three rounds of the e-Delphi study between September and November 2020. Consensus was reached on nine AHP public health research priorities. ConclusionSeveral areas of AHP public health research were identified as priority, however, a number of priorities refer to the impact of AHP public health activities as opposed to empirical research. The identified priorities will be used to progress the AHP public health research agenda through a UK wide AHP public health strategy implementation group and through support and engagement from the AHP professional bodies and arm's length bodies.

Agencification in Greece: a parallel public sector?

PurposeThe purpose of this paper is to provide insights into the impact of agencification on the process of administrative reorganization in Greece. It is suggested that agencies tend to create a parallel administrative space that operates disjointly or even detached from the central bureaucracy. This hypothesis is tested and elaborated in relation to Greece's centralist administrative tradition.Design/methodology/approachThe analysis identifies the critical junctures of the domestic agencification pattern and seeks to explain its evolution on the basis of historical-cultural factors, rational choice explanations and country-specific variables. The methodology combines quantitative and qualitative research. Along with a review of existing literature, data were collected through semi-structured interviews and the Registry of Entities and Agencies.FindingsThe findings show that agencification never became a coherent policy reform tool, while its outcomes were filtered by the centralist and politicized tradition of the Greek state. The effect of agencification was proved to be highly path-dependent and contingent upon the broader administrative tradition. The agencification policy does not follow a clear direction and has been shaped as a random combination of ad hoc decisions, external pressures and domestic politics.Research limitations/implicationsThe paper provides some generalizations of the agencification experience. However, they do not cover all specificities and particularities of agencies and their applicability varies. Further research could consider these variations.Originality/valueA novelty of this study is that it links the agencification effect with three key aspects of the administrative reform process, namely, decentralization, debureaucratization and depoliticization. In addition, no single study exists regarding agencification in Greece; thus, the paper is the first to provide an overall view of the Greek arm's length bodies.

Local governments and their arm’s length bodies

ABSTRACT In this paper, we discuss the state of the art on the creation of arm’s length bodies (ALBs) by local governments. We make three main contributions. First, there are many different types of ALBs and each country has its own categories; an expert survey was held identifying three common types of body, to enable future comparative research. Second, we point out that the creation of ALBs has led to a number of new challenges for local governments, particularly regarding governing bodies at arm’s length to ensure ALBs’ good performance. A lack of capacity and information have to be countered, for example, by increased monitoring – also for democratic accountability purposes. Special attention is needed for the multiple principal problem that arises when local governments jointly create ALBs. Third, research into local ALBs is still in its early stages. We present a research agenda to develop knowledge on the topic.

Enacting localist health policy in the English NHS: the 'governing assemblage' of Clinical Commissioning Groups.

Objectives The Health and Social Care Act 2012 introduced Clinical Commissioning Groups to take responsibility for commissioning (i.e. planning and purchasing) the majority of services for local populations in the English NHS. Constituted as 'membership organizations', with membership compulsory for all GP practices, Clinical Commissioning Groups are overseen by, and are accountable to, a new arm's-length body, NHS England. This paper critically engages with the content and policy narrative of the 2012 Act and explores this in relation to the reality of local policy enactment. Methods Set against a careful review of the 2012 Act, a case study of a nascent Clinical Commissioning Groups was conducted. The research included observations of Clinical Commissioning Group meetings and events (87 h), and in-depth interviews (16) with clinical commissioners, GPs, and managers. Results The 2012 Act was presented as part of a broader government agenda of decentralization and localism. Clinical Commissioning Group membership organizations were framed as a means of better meeting the needs and preferences of local patients and realizing a desirable increase in localism. The policy delineated the 'governing body' and 'the membership', with the former elected from/by the latter to oversee the organization. 'The membership' was duty bound to be 'good', engaged members and to represent their patients' interests. Fieldwork with Notchcroft Clinical Commissioning Group revealed that Clinical Commissioning Groups' statutory duty to NHS England to 'ensure the continuous improvement' of GP practice members involved performance scrutiny of GP practices. These governance processes were carried out by a varied cast of individuals, many of whom did not fit into the binary categorization of membership and governing body constructed in the policy. A concept, the governing assemblage, was developed to describe the dynamic cast of people involved in shaping the work and direction of the Clinical Commissioning Group, many of whom were unelected and of uncertain status. This was of particular significance in Notchcroft Clinical Commissioning Group because the organization explicitly pursued a governance system based on developing positions of consensus. The governing assemblage concept is valuable in articulating the actual practices of Clinical Commissioning Group governance, how these relate to the normative content of the 2012 Act, and the tensions that emerge. Conclusions The governing assemblage concept provided clarity in discussion of the dynamics of organizational governance in Notchcroft Clinical Commissioning Group, which did not follow the simple template articulated in the 2012 Act. The concept merits application in the study of other Clinical Commissioning Groups and may prove valuable in illuminating governance processes within a range of other health care organizations in different contexts. The governing assemblage holds promise for the analysis of ongoing changes to NHS organization, as well as international health care organizations such as accountable care organizations in the US.

Delegation in Hard Times: The Financial Management of Arm's Length Bodies in the UK

AbstractThis paper explores the effectiveness of financial management tools in regulating the use of resources by arm's length bodies (ALBs) in a period of fiscal stress. The paper presents research undertaken into the implementation of a new financial management tool for ALBs in the UK since the 2008 financial crisis. Drawing on conflict ambiguity theory, the paper shows how the effectiveness of such tools is affected by deep‐rooted tensions implicit within public governance. This gives rise to micro‐level conflict over the means of achieving fiscal regulation, underpinned by macro‐level ambiguity over the logic of governance pursued by the government.

The WPA Action Plan 2014-2017.

The WPA Action Plan 2014-2017.

THE CENTRE STRIKES BACK: META‐GOVERNANCE, DELEGATION, AND THE CORE EXECUTIVE IN THE UNITED KINGDOM, 2010–14

A growing literature on ‘agencification’, ‘quangocratization’, and the ‘autonomization’ of the state has highlighted a coordination dilemma in contemporary public governance whereby governments rely on delegated governance but are frustrated by the lack of control that arises from such structures. In the run‐up to the 2010 General Election in the United Kingdom this coordination dilemma was prominent as the capacity of the Cabinet Office to exert control over arm's‐length bodies, either directly or indirectly, received intense criticism. This article presents the findings of the first detailed research project to examine the subsequent Coalition Government's approach to this dilemma. It argues that in relation to the governance of public bodies, the role and capacity of the Cabinet Office has been transformed. In mapping this development the article explores the implications of the centre striking back in the context of ‘post‐New Public Management’ reforms.

The place of popular music in Scotland's cultural policy

In the last two decades the status of popular music as both a cultural activity and creative industry has changed significantly in Scottish and UK cultural policy. The change is in line with a broader shift away from thinking of the arts as cultural activity in need of subsidy and towards treating them as part of the creative economy. The current cultural policy landscape pertaining to popular music is mapped out, drawing on interviews and an online survey with members of the Scottish Music Industry Association (SMIA) and complementary interviews with stakeholders from relevant government and arms-length funding and development bodies. The Scottish Government's (SG) White Paper on independence highlighted the creative industries as one of five growth sectors key to the Scottish economy, but for popular music – and in line with the global music industry – many working in the Scottish music industry face acute challenges. Given EU regulations (and the Scottish Government's preference to remain in the EU) and international agreements in areas like broadcasting and copyright, if they are to flourish many members of the SMIA will likely need to strengthen their relationships with the wider UK and global music industry, regardless of the outcome of the referendum on independence.

Quangos—Why Bother Counting Them When Whitehall Can't?

Abstract‘Mindless’ empiricism rules in British central government, bolstered by the use of prerogative powers and the absence of any ‘court of appeal’ to insist on definitions and uniformities. This gives arguments about quangos—arm's‐length bodies—a surreal quality. The Cameron coalition has created many new quangos, while claiming a cull. Unless and until Whitehall acquires, or is forced to acquire, better habits of mind, it may be a waste of time for academics and reformers to prepare taxonomies and call for more administrative rationality.

The Quango Conundrum Revisited—Why the Government Still Needs a More Coherent Approach to Arm's‐Length Bodies

AbstractThere has been substantial reform of public bodies since the Coalition government was formed in 2010. But although numbers have been reduced, there has been no attempt to address the confused landscape—indeed, departments have interpreted criteria for what should be put at arm's length in different ways, introducing further complexity. A clearer link between function and form is needed. This would help address some of the blurred lines over accountability that we have seen in the recent rows over Ofsted and the Environment Agency.

Bonfires and Barbecues: Coalition Governance and the Politics of Quango Reform

The use of arm's-length bodies to deliver certain services, to regulate certain sectors or to assume responsibility for particularly salient political issues is neither new in historical terms or a feature unique to the UK in comparative terms. What is particularly distinctive, however, is the Coalition Government's attempts since 2010 to reduce the number of ‘quangos’ while also strengthening the capacity of the core executive and sponsor departments to control and co-ordinate this dense and fragmented sphere of delegated governance. Drawing upon the findings of the first research project to analyse the current Public Bodies Reform Agenda, this article provides an account of the ‘filling-in’ of the ‘hollowing out’. It argues that when viewed through a historical lens, the Coalition Government has adopted a distinctive approach to ‘the quango problem’.