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 multilevel
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