ارقام تنظیمی: مشارکت، بودجه بندی و مدرن سازی دولت

This paper examines the ‘modernising government’ initiative in the UK, and the ‘flexibilities’ – lead commissioning, integrated provision, and pooled budgets – introduced in the Health Act 1999. This policy reform, and the associated tools to operationalise it, placed ideas of cooperation and partnership at the heart of inter-organizational relations in the domain of public administration, and gave prominence to the roles of management control practices in facilitating cooperation. We consider how the ideals of cooperation and partnership were discursively articulated, how professional and administrative boundaries were given visibility in particular legal cases, and what happened when local practitioners sought to make these ideals operable. We demonstrate how cooperation initially emerged as a ‘local’ phenomenon, both prior to and subsequent to the Health Act 1999. We then examine how those delivering services sought to mediate pragmatically between legal and policy injunctions to engage in formal cooperation, and the imperative to provide services across organizational and professional boundaries. Finally, we consider the limits of cooperation across organizational boundaries in settings with strongly developed professional enclosures. The paper draws on both archival material and fieldwork to examine what are termed ‘regulatory hybrids’ – those inter-organizational processes, practices and expertises that are formed from two or more elements that previously existed separately, and that emerge in part out of regulatory or judicial interventions rather than simply the imperatives of voluntary coordination. The paper seeks to build on suggestions for developing the links between the accounting and public administration literatures, and it draws on ‘governmentality’ studies to analyse the phenomenon. This argues for the importance of considering three distinct and interrelated layers or levels of analysis: the programmatic or discursive, the practices and processes to which such discourses are intrinsically linked, and the professional ‘enclosures’ that can emerge in some domains. While drawing on governmentality studies, we also suggest extending them by paying greater attention than is customary in such writings to localised processes and practices. In particular, we propose the concept of ‘mediating instruments’ to explain how management control practices link the larger political culture with the ‘everyday doings of practitioners’.

More than two decades of research by scholars of organizations have demonstrated the importance of inter-organizational relationships, and the existence of hybrid or intermediate organizational forms (Eccles, 1981, Granovetter, 1985, Nohria and Eccles, 1992, Powell, 1985, Powell, 1987, Powell, 1990, Teece, 1996, Williamson, 1979, Williamson, 1985 and Williamson, 2002). During the last decade, accounting scholars have begun to explore the roles of accounting in inter-organizational relations, and within networks of organizations (Baxter and Chua, 2003, Busco et al., 2006, Cooper and Slagmulder, 2004, Dekker, 2003, Dekker, 2004, Dekker, 2008, Håkansson and Lind, 2004, Hopwood, 1996, Ittner et al., 1999, Meer-Kooistra and Vosselman, 2000, Meer-Kooistra and Vosselman, 2006, Miller and O’Leary, 2005, Miller and O’Leary, 2007, Mouritsen, 1999, Mouritsen et al., 2001, Seal et al., 2004 and Tomkins, 2001). However, the bulk of this work to date within accounting has focused on the private sector, with little attention paid to inter-organizational relations within the public sector (Brignall and Modell, 2000, Clarke and Lapsley, 2004, Kurunmäki, 1999, Kurunmäki, 2004, Kurunmäki and Miller, 2006, Lapsley and Wright, 2004, Lehtonen, 2007, Llewellyn, 1991, Llewellyn, 1994, Miller et al., 2008, Modell et al., 2007, Northcott and Llewellyn, 2003 and Meer-Kooistra and Scapens, 2008). This paper seeks to help remedy this deficit, by considering the roles of management control systems in the context of inter-organizational relations in the domain of public administration. The example we focus on is the ‘modernising government’ policy that emerged in the UK in the late 1990s. This promoted ‘partnership working’ and the use of ‘flexibilities’, including novel budgeting practices, through the 1999 Health Act. We suggest that analysing these reforms illustrates something distinctive about inter-organizational relations and management control in the domain of public administration: the existence of what we term ‘regulatory hybrids’, those inter-organizational processes, practices and expertises that are formed from two or more elements that previously existed separately, and that emerge in part out of regulatory or judicial interventions, rather than simply from the imperatives of voluntary coordination (Kurunmäki, 2004 and Miller et al., 2008). The importance of noting the distinctiveness of such inter-organizational relations is attested by the public administration literature, which for many years has demonstrated that matrix organizations, inter-agency coordination, and complex networks are not only relatively common in the delivery of public services, but likely to increase still further in number and importance (Agranoff, 1986, Bardach, 2001, Berry et al., 2004, Bevir and Rhodes, 2003, Mandell, 1988, O’Toole, 1997, Page, 2004, Provan and Milward, 2001 and Rhodes, 2000). Also, whereas networks have been a focus of public policy scholars since at least the 1960s, attention in the past decade has focused increasingly on complex networks and multiple interactions including information sharing across agency and programme lines (Provan and Kenis, 2008 and Provan and Milward, 2001). It is important to obtain an empirically accurate picture of such networks, in order to understand the contexts in which the network's actors are embedded (Berry et al., 2004). As Modell et al. (2007) have argued recently, there is much to be gained by attending to the potential links between accounting and public administration research. While the latter draws attention to a range of public policy issues, including for instance the fragmentation of public service delivery and calls for a new performance management ethos, the former offers the opportunity to build on a substantial body of empirical work on the potential consequences of management control systems and their varying logics. This paper seeks to build on these suggestions for developing the links between the accounting and public administration literatures. Specifically, we aim to demonstrate how inter-organizational and hybrid organizational relations have recently been discursively articulated as a public policy objective, how a particular policy initiative has sought to operationalise them through specific management control practices, and what happens when these aspirations come into contact with strongly defined professional groupings and boundaries. The research has been conducted through a mixture of archival study and fieldwork, in an attempt to understand the interrelations between large-scale policy changes and the localised operation of these through particular management control practices. We do not seek to explain the efficacy of the new arrangements, or to identify those characteristics of networks that lead to successful performance outcomes (e.g. Berry et al., 2004). We do, however, point to some possible obstacles to the development of partnership working, most notably the way in which professional ‘enclosures’ can, in strongly professionalised contexts, limit the possibilities for the creation of inter-organizational or hybrid forms. We employ concepts drawn from the ‘governmentality’ literature to analyse this phenomenon (Foucault, 1991, Miller and Rose, 2008 and Rose and Miller, 1992). This rather awkward term governmentality can give rise to confusion, particularly in relation to more contemporary or current notions such as ‘governance’, government and ‘the’ government. It is used here in the sense defined initially by Foucault (1991, p. 102), as “the ensemble formed by the institutions, procedures, analyses and reflections, the calculations and tactics that allow the exercise of this very specific albeit complex form of power” that arose since the sixteenth century. Defined somewhat more broadly, it refers to those forms of indirect means of governing or acting on the behaviours or actions of individuals and groups of individuals, together with the varied ways in which the exercise of such modes of governing are reflected on and articulated discursively. Governmentality studies alert us to the importance of considering three more or less distinct layers or levels of analysis, and their interrelations: the programmatic or discursive; the practices, processes and instruments to which they are intrinsically linked; and the professional or ‘expert’ knowledges through which they are made operable, and which can give rise to ‘enclosures’ in some domains (Rose and Miller, 1992). This approach has been used successfully in accounting research and in many other domains, and we suggest that it can be usefully employed to analyse the emergence of particular types of inter-organizational relations in the context of the modernising government reforms.1 But, while it has proved fruitful in analysing large-scale shifts in ‘modes of governing’ – for instance in relation to factories, prisons or social life more generally2 – to date it has been little used to examine the interrelations between large-scale policy reforms and the more localised re-design of management control practices and organizational arrangements for service delivery. In seeking to extend the governmentality literature in this respect, this article is necessarily exploratory and tentative, but we suggest it demonstrates the potential for further extensions of governmentality studies. In accordance with the governmentality approach, we consider first the programmatic or discursive dimension of appeals to engage in inter-organizational cooperation through partnership working and use of the Health Act ‘flexibilities’ ( Ezzamel et al., 2007, Miller and Rose, 1990, Miller and Rose, 2008, Rose and Miller, 1992, Morrison and Morgan, 1999 and Wise, 1988). We examine how partnership working emerged in relation to abstract ideals articulated through various proposals that sought to re-design the delivery of services in ways considered ‘modern’. Government reports, committees of inquiry, White Papers, the advice of consultants and academics, all helped articulate general political ideals concerning the ‘modern’ ends to which government should be addressed, and in the broadest terms how these should be delivered. These were more than wishes or intentions. They were ways of representing a domain such that it could be treated as an object of conscious political calculation and intervention. Governmentality research highlights the importance of attending to these often highly abstract values and goals, the generalised aspirations and ideals that are mobilised and articulated by a wide range of regulatory agencies and policy designers as they seek to re-design organizations and their interrelations. Second, and equally importantly, governmentality scholars emphasise the various practices and processes through which administrative re-design – in this instance the creation of novel inter-organizational interrelations and management control mechanisms – is sought. In this respect, we seek to extend governmentality research by paying greater attention than is customary in such studies to the localised processes and practices through which programmes of government are made operational (Mennicken, 2008). Drawing on science studies, we propose the concept of ‘mediating instruments’ as a way of addressing this issue. Most generally, this means considering the ways in which a set of practices or instruments comes to embed distinct and possibly competing ideas into an operating ensemble. The instrument may be a machine, as Wise (1988) demonstrated with respect to the steam engine and the electric telegraph. It may be a model, as Morrison and Morgan (1999) demonstrated with respect to the Leontief input–output model. Or it may be a ‘law’, as Miller and O’Leary (2007) demonstrated with respect to “Moore's Law”. Mediating instruments can link domains such as science and the economy, politics and medicine, or medical and social care. Mediating instruments operate as both means of representation and means of intervention, connecting with, yet remaining distinct from the object of intervention. Our particular concern in this paper is with how such processes of mediation work out at the local level, and how the larger political culture interacts with the “everyday doings of practitioners” (Wise, 1988, p. 78). We address this in the particular context of the Modernising Government reforms and the ‘flexibilities’ introduced in the 1999 Health Act. We suggest it is important to attempt to understand how the emergence of new forms of inter-organizational cooperation and management control practices – new ways of structuring, assessing and monitoring work, and new ways of allocating and controlling resources through novel budgeting practices – are understood and framed in terms of both larger political ideals and localised concerns for service delivery. We suggest that focusing on such processes allows us to understand how these administrative reforms entail mediation between larger political transformations and the local concerns and preoccupations of practitioners of varied types. As actor-network theory has emphasised, this is not a uni-directional process, but entails assembling and linking together disparate and possibly competing sets of actors, activities and aspirations.3 We suggest that scholars concerned with management control in the context of public administration should pay more attention to these discursive and instrumental processes of mediation, so as to better understand the conditions that give rise to, or hinder, the creation of novel inter-organizational practices and relations. Third, and once again in accordance with the governmentality literature, we consider the professional enclosures that can arise in certain domains. By enclosures, we mean relatively bounded domains or modes of judgement and evaluation within which and through which the authority of a particular group of experts or professionals comes to be associated and concentrated. Enclosures may form around esoteric knowledge, technical skill, established position, or the control of resources ( Kurunmäki, 1999, Kurunmäki, 2004 and Rose and Miller, 1992). While such enclosures are not fixed and are subject to contestation, they can none the less play an important role in hindering inter-organizational cooperation. We suggest that this is more likely in highly professionalised contexts, such as health and social care, with their attendant clearly demarcated organizational boundaries. For inter-organizational cooperation, and the management control practices designed to facilitate it, can be hampered if one professional group or another seeks to translate the aspirations of policy reformers into their own interests, reinforcing existing modes of working rather than re-designing them in line with policy initiatives. We suggest that a focus on the varying strength of professional enclosures and boundaries – both across different service domains and different national contexts – can help us analyse the conditions under which inter-organizational cooperation and associated management control practices can emerge. These three levels of analysis suggested by governmentality studies are, we propose, complementary to some existing concerns in the public administration literature, as well as with recent calls to widen the analysis of management accounting research by examining the interplay between management control and the broader political and institutional environment (Dillard et al., 2004 and Modell et al., 2007). The focus on changing patterns of governance, defined as the aggregates of “the patterns of thought that inform a political practice” (Bevir and Rhodes, 2003, p. 42), is similar to our focus here on the programmatic or discursive aspect of modes of governing. Bevir and Rhodes (2003) trace the patterns of thought informing British governance, and document the shifts from hierarchies to markets, and then to networks. While endorsing their emphasis on the beliefs or concepts that inform differing modes of governance, we seek to go beyond their analysis of aggregates of concepts by unpacking the ideas and beliefs behind particular policies, and by considering also the practices and processes through which their enactment is sought, and the ways in which professional enclosures can limit the development of inter-organizational relations. As O’Toole (1997) argues, the limits that liberal political theory imposes on government intervention can encourage the further development of inter-organizational and network forms for service delivery, paradoxically extending the reach of government programmes while loosening their immediate managerial grasp. While much has been accomplished by researchers in the intervening decade, there still remains much to be done, particularly for those topics that reside at the intersection of more than one discipline. This is the case for our concern here with the ‘modernising government’ and ‘partnership working’ policies. To understand these initiatives adequately, we suggest, requires consideration of the dynamics that arise at the intersection of practices or processes for enacting management control, the programmatic or discursive ideals that animate them and help define their roles, and the professional enclosures they may come into contact with. It is to a consideration of these interactions that we now turn. The next section describes these policies in greater detail, and also the methodology followed in this study. The following sections consider, in turn: the emergence of the cooperative ideal in both policy and judicial contexts; the ways in which these ideals intersected with local formulations of joint and partnership working; and the encounters between management control practices, cooperative ideals, and particular professional enclosures.

This paper has examined the ‘modernising government’ reform programme, and more specifically the ‘flexibilities’ (lead commissioning, integrated provision and pooled budgets) introduced in the Health Act 1999. Through a mixture of archival research and fieldwork, we have explored the early experiences of those experimenting with these new possibilities for inter-organizational cooperation. These ‘flexibilities’ placed management control practices at the centre of inter-organizational and inter-professional cooperative arrangements in public administration. We have examined how the ideals of cooperation and partnership were discursively articulated, how professional and administrative boundaries were given visibility in particular legal cases, and what happened when local practitioners sought to make these ideals operable across strongly defined professional and organizational boundaries or enclosures. We have argued for attention to ‘regulatory hybrids’, suggesting that the hybrid organizational practices and processes that emerge out of regulatory interventions are a distinctive feature of inter-organizational relations and management control in the domain of public administration. To analyse these issues, we suggested that much can be gained by linking the public administration literature, which has long been concerned with inter-organizational and network forms, with the literature on accounting and inter-organizational relations. We drew on the governmentality literature to analyse these issues, focusing on three dimensions: the programmatic or discursive articulation of ideals of cooperation and partnership working; the practices and processes through which administrative re-design was sought; and the professional enclosures that can arise in certain domains. We focused in particular on the interactions between healthcare and social care (Miller and Rose, 2008). Consistent with Modell et al. (2007), this approach meant emphasising the multi-level nature of the analysis, with particular attention being given to the interrelations between the different levels or layers. While the public administration literature (e.g. Bevir and Rhodes, 2003) has examined the changing patterns of thought informing governance models, and the attendant shift from hierarchies to markets, and then to networks, we argue for exploring the links between changing discursive frameworks and the practices and processes that operationalise them and at times constrain them. The discursive articulation of policies regarding partnership working comes into contact repeatedly, and in different settings, with management control practices such as budgeting, resource allocation and accountability mechanisms, and with the organizational and professional enclosures that characterise public services such as healthcare and social care. Reciprocally, those delivering services not only have to maintain the delivery of services, but they also have to articulate that delivery and their daily work in terms that may be discrepant with, or at least not wholly aligned with their organizational and professional boundaries and logics. Management control practices reside, as it were, at the intersection of a variety of discursive and professional expectations, which are accorded particular significance in the case of reform processes such as those considered here which seek to promote regulatory hybrids. While drawing on the governmentality literature, we argued that it needs to be extended beyond existing concerns with large-scale discursive and regulatory shifts, to consider what happens when such reforms come into contact with the localised aspirations and activities of service providers. Here, we drew upon the notion of ‘mediating instruments’ that has been successfully used in the science studies literature, and more recently in accounting. We considered how this notion helps us to understand the ‘everyday doings’ of local practitioners. The aim was to preserve the focus on the programmatic or discursive aspect of regulatory and administrative reform, while understanding how it interacts with more localised ideals and practices, which can range from attempts to operationalise de-institutionalisation policies (for people with learning disabilities), to the specifics of designing forms to report and cost the different inputs of various professional groups, or designing new organizational processes within which multiple professional groups can interact. The notion of mediating instruments suggests focusing less on the entities that populate a domain, and paying greater attention to the linkages between them, and particularly the instruments that act as intermediaries by connecting actors, agencies and aspirations. For it is through these, and particularly through the management control practices deployed, that a working ensemble can be formed out of all the components and practices that make up the increasingly complex sphere of public service provision. Rather than viewing management control practices as simply the ‘implementation’ of policy, they are viewed as interdefined with the political, professional and organizational categories that animate them. We suggest that this focus indicates the need to broaden the study of inter-organizational relations and management control to include not only organizational forms, but the practices and processes through which they are made operable (Miller et al., 2008). These may be formalised, as in the ‘notifications’ required for all partnership proposals submitted as part of the Health Act 1999, including governance arrangements, specification of functions to be included, complaints procedures and dispute resolution mechanisms. But they may also be relatively localised, such as the County Wide Assessment Team devised in one site, or the forms produced for the recording of costs and inputs. We suggest that greater attention to these ‘mediating instruments’ can help us to understand better how local practitioners combine the imperatives of continued and even enhanced service delivery with the injunction to adhere to new regulatory reforms or legal categories. For it is in such settings that management control practices in the public sector are increasingly having to operate: at the intersection of highly abstract reform processes couched in the language of cooperation, professional boundaries that can be very strongly defined, and management control practices that have to enable information exchanges and modes of reporting that respect administrative boundaries while seeking to attenuate them. Our fieldwork reported in Section 4 demonstrated how cooperation can exist and even flourish at a local level, albeit within certain parameters, how it can develop more pragmatically as a way of ‘mediating’ between the expectations of reformers and the immediate needs of service delivery, and how it can encounter rather more fundamental limits as a result of strongly defined professional enclosures. This suggests that future research should pay more attention to the ways in which management control practices in the field of public administration encounter inter-professional boundaries and enclosures, and the implications this has for developing still further inter-organizational cooperation and control practices. Our fieldwork suggests also that greater attention should be paid to the rather more modest ‘mediating instruments’ that emerge and are formed within such processes, for it is through these that the discursive aspirations of policy makers are brought into contact with the organizational and professional boundaries that characterise domains such as healthcare and social care. Inter-organizational management controls act, as it were, as an intermediary in the interplay between public administration and professional enclosures. This is consistent with what has been noted in the very different setting of the microprocessor industry with respect to ‘roadmapping practices’ (Miller and O’Leary, 2007), which have been viewed similarly as instruments of mediation. There, a dense network of information exchanges across organizational boundaries has developed over a period of several decades, resulting in a large amount of information sharing that one would not normally expect in competitive situations. Accounting researchers, together with organization scholars, sociologists and economists, have to date paid relatively little attention to such information exchanges, focussing instead more on the entities that populate the socio-economic world, rather than the instruments and processes that link them. The analogy with the microprocessor industry is that cooperation can be enhanced through the creation of settings in which information can be exchanged, formally separate administrative or professional groups can meet, and instruments can be devised that provide visibility to the norms and expectations of different parties. This allows the assessment of instruments, policies and time-lines, together with negotiation over their alignment. While we did not observe in our research major steps being taken towards the formal pooling of budgets, or the creation of new integrated entities, we did observe novel working and management control practices that spanned organizational and professional boundaries. We suggest that greater attention should be paid to these apparently more modest steps, and the practices or instruments that facilitate them, for these can help us understand better what may be required to extend cooperation and partnership working even in situations where organizational and professional boundaries are highly developed. For instance, localised management control practices that demonstrate the relative inputs of distinct professional groups, or forums that bring together these groups into decision-making entities, can provide assurance with respect to financial flows and potential dialogue across professional boundaries. Put differently, by emphasising the multi-level nature of the phenomenon we are investigating, and the importance of attending to intermediaries rather than entities, we may better understand the roles played by inter-organizational management controls in the context of public administration. Finally, by conducting research in a variety of sites dealing with diverse client groups (the elderly, children, and people with learning disabilities), we were able to document the complex regulatory and policy world in which inter-organizational relations and management control in public administration exists. This was not simply a matter of appreciating the difficulties of ‘implementation’ of the Health Act 1999 ‘flexibilities’. Rather, it was a matter of examining the ways in which this particular reform process comes into contact with many other reform and regulatory processes, such as the de-institutionalisation of people with learning disabilities, the ‘star ratings’ for hospitals, and the new focus on ‘failing services’. By examining the ways in which ‘regulatory hybrids’ emerge out of the everyday doings of practitioners, and in relation to large-scale reform processes such as the modernising government agenda, we were able to chart the multiple roles that management control practices play in local settings in public administration. Future research could usefully examine developments subsequent to these early experiences of experimenting with the flexibilities introduced in the Health Act 1999. This could, for instance, include analysing the conditions under which formal partnerships prosper or perish. It could, perhaps, focus on particular services such as learning disability or mental health, where formal partnership arrangements seem to have developed to a greater extent than in areas such as services for older people (Goldman, 2010, p. 6). It should, in any event, take into account the curious paradox of the continuing strong policy commitment to formal partnership working, combined with the persistent relatively low take-up overall of joint financing at the national level.17 One thing that is clear, however, is that formal partnership working has remained at the forefront of public policy across the whole of the decade that has elapsed since the Health Act 1999. For instance, Section 75 of the NHS Act 2006 restated in identical terms the provisions of Section 31 of the Health Act 1999 regarding ‘flexibilities’. Published in the same year, the White Paper Our Health, Our Care, Our Say (CM 6737, 2006) affirmed the importance of joint commissioning of services, while High Quality Care for All (CM 7432, 2008) – the final report of Lord Darzi's ‘Next Stage Review’ – also stressed the central role played by joint arrangements in care provision. It remains to be seen what will happen under the new coalition government, although initial indications are that formal partnerships are here to stay. The White Paper Equity and Excellence: Liberating the NHS (CM 7881, 2010), published only two months after the creation of the new government, not only reaffirmed the importance of partnership working but broadened its focus still further. The proposal to create consortia of GP practices placed partnership working once again at the heart of health and social policy, while the appeal to the need for partnerships between patients and clinicians extended the rhetorical remit of the notion of partnership. Inter-agency cooperation as a policy objective, and the multiple modes of partnership working that may make it operable, seem set to stay for the foreseeable future, while there is no reason to assume that the longstanding obstacles to such cooperation created by professional and organizational enclosures are in any way attenuated.