Creating change in government to address the social determinants of health: how can efforts be improved?

Background - The evidence base for the impact of social determinants of health has been strengthened considerably in the last decade. Increasingly, the public health field is using this as a foundation for arguments and actions to change government policies. The Health in All Policies (HiAP) approach, alongside recommendations from the 2010 Marmot Review into health inequalities in the UK (which we refer to as the ‘Fairness Agenda’), go beyond advocating for the redesign of individual policies, to shaping the government structures and processes that facilitate the implementation of these policies. In doing so, public health is drawing on recent trends in public policy towards ‘joined up government’, where greater integration is sought between government departments, agencies and actors outside of government. Methods - In this paper we provide a meta-synthesis of the empirical public policy research into joined up government, drawing out characteristics associated with successful joined up initiatives. - We use this thematic synthesis as a basis for comparing and contrasting emerging public health interventions concerned with joined-up action across government. Results - We find that HiAP and the Fairness Agenda exhibit some of the characteristics associated with successful joined up initiatives, however they also utilise ‘change instruments’ that have been found to be ineffective. Moreover, we find that – like many joined up initiatives – there is room for improvement in the alignment between the goals of the interventions and their design. Conclusion - Drawing on public policy studies, we recommend a number of strategies to increase the efficacy of current interventions. More broadly, we argue that up-stream interventions need to be ‘fit-for-purpose’, and cannot be easily replicated from one context to the next

Organising for growth:Irish state administration 1958-2008

This paper analyses some key features of Irish public administration as it has developed since the foundation of the state, paying particular attention to the period from the late 1950s onward. During these decades, notwithstanding successive waves of concern expressed over the need for public sector reform, the evidence suggests an underlying lack of coherence in the evolution of the public administration system that resulted in a poor capacity for effective policy coordination. Yet the drive toward economic modernisation also resulted in the creation of new state competence to support industrial development both directly and indirectly. These changes can be tracked organisationally, drawing on the database of the IRCHSS-funded Mapping the Irish State project

Sharing services, saving money? Five risks to cost saving when organizations share administrative services

Shared services are a popular reform for governments under financial pressure. The hope is to reduce overheads and increase efficiency by providing support services like HR, finance and procurement once to multiple agencies. Drawing on insights from organization theory and political science, we identify five risks that shared services won’t live up to current expectations. We illustrate each with empirical evidence from the UK, Ireland and further afield, and conclude with suggestions on how to manage these risks

Collaborative cost cutting: productive efficiency as an interdependency between public organizations

Collaboration between public sector organizations is typically understood as a response to complexity. Agencies collaborate in order to address complex, cross-cutting policy needs that cannot be met individually. However, when organizational size is a constraining factor in public service efficiency, collaboration can also reduce costs by capturing scale economies unavailable to organizations of sub-optimal size. Using organization theory, the article conceptualizes these two different triggers for public sector collaboration, and builds a framework for tracing their wider impact upon the formation, operation, and outcome of inter-agency partnerships. The framework is illustrated, and its implications for future research are explored

Quango reform: The next steps?

The coalition government elected in 2010 in the UK pursued a programme of quango reform focused on reducing the number and expenditure of arm’s-length bodies, increasing transparency, improving accountability and maximizing efficiency and effectiveness. This paper revisits Flinders and Skelcher’s 2012 PMM paper ‘Shrinking the quango state: five challenges in reforming quangos’ to assess progress to date and consider future challenges. Drawing insights from the UK programme of quango reform, as well as similar developments in Ireland, the authors identify five new challenges for governments: regulating, managing, reconciling, co-ordinating and reflecting