Therese Dwyer Løken, Marit Kristine Helgesen, Halvard Vike and Catharina Bjørkquist
New Public Management (NPM) has increased fragmentation in municipal health and social care organizations. In response, post-NPM reforms aim to enhance integration through service…
Abstract
Purpose
New Public Management (NPM) has increased fragmentation in municipal health and social care organizations. In response, post-NPM reforms aim to enhance integration through service integration. Integration of municipal services is important for people with complex health and social challenges, such as concurrent substance abuse and mental health problems. This article explores the conditions for service integration in municipal health and social services by studying how public management values influence organizational and financial structures and professional practices.
Design/methodology/approach
This is a case study with three Norwegian municipalities as case organizations. The study draws on observations of interprofessional and interagency meetings and in-depth interviews with professionals and managers. The empirical field is municipal services for people with concurrent substance abuse and mental health challenges. The data were analyzed both inductively and deductively.
Findings
The study reveals that opportunities to assess, allocate and deliver integrated services were limited due to organizational and financial structures as the most important aim was to meet the financial goals. The authors also find that economic and frugal values in NPM doctrines impede service integration. Municipalities with integrative values in organizational and financial structures and in professional approaches have greater opportunities to succeed in integrating services.
Originality/value
Applying a public management value perspective, this study finds that the values on which organizational and financial structures and professional practices are based are decisive in enabling and constraining service integration.
Details
Keywords
In Michael Lipsky’s intriguing analysis of the performance of public bureaucracy – in his classic Street-level Bureaucracy (1980) – he shows, for example, the professional…
Abstract
In Michael Lipsky’s intriguing analysis of the performance of public bureaucracy – in his classic Street-level Bureaucracy (1980) – he shows, for example, the professional discretion they apply may not only involve adapting policy to the individual case, meet real needs in the population, prevent patients, clients, students or users from getting access, etc., but at the same time both have profound policy implications and take very ‘political’ forms. In this chapter, I argue that it is regrettable that Lipsky did not establish a comparative framework for his study. Based on my own ethnographic research in local politics and bureaucratic practice in the municipal world in Norway, I look more closely at the relative autonomy of street-level bureaucracy within the context of universalism – a hallmark of the Nordic welfare state model (Esping-Andersen 1998, 2009) – and explore how it is utilised. The Nordic welfare states are among the most ‘service intense’ states in the Western world, and the personnel working directly with patients, students, clients, etc., play a major role in linking ‘the state’ to the population (Papakostas, 2001, Vike et al., 2002). Thus, the role of the Nordic welfare state’s street-level bureaucracy as a key interface between the state and the population is hard to overestimate (Leira & Sainsbury, 1994). Moreover, as universalism also tends to stimulate what we may call a culture of strong claims (to services) among the population at large, street-level bureaucrats may be able to form strong alliances with other actors, and thus play an important part of the dynamics of power in local politics – where fundamental policy principles such as universalism is at stake.