The Dynamics of Public Policy by Adrian Kay PDF
The Dynamics of Public Policy by Adrian Kay PDF
The Dynamics of Public Policy by Adrian Kay PDF
Adrian Kay
Department of Politics and Public Policy, Griffith University,
Brisbane, Australia
Edward Elgar
Cheltenham, UK Northampton, MA, USA
Contents
vi
vii
Abbreviations
Preface and Acknowledgements
1
PART I
2
3
4
5
6
7
8
9
THEORY
PART II
17
29
42
59
EVIDENCE
77
90
104
118
131
143
References
Index
Abbreviations
ACTU
AFR
BBR
BMA
CAP
CCT
CE
CoAM
CRL
DHA
DoH
EU
FE
GATT
GDP
GNP
HI
IIA
NCE
NGO
NHS
NHSE
NICE
OECD
OR
PACT
PCGs
PCTs
PPRS
R&D
SFP
VIL
VPRS
WTO
vii
1.
common in policy studies (for example, Parsons 1995; Hudson and Lowe
2004).
Most importantly economics, like public policy, depends on human
decisions. All decisions are made in historical contexts; they are inevitably
influenced by the legacy of the past and the uncertainty of the future. Thus the
description of individual decisions requires a sense of memory and
expectation; these are subjective, personal and partial and therefore not suited
to the formalism of economic models, notwithstanding theoretical advances in
game theory on memory and expectation in repeated games.
One common and essential element in most writers use of the term policy
is purposiveness of some kind (Parsons 1995, pp. 1316). Policy expresses a
general set of objectives or a desired state of affairs. These are constrained by
a sense of possibility driven by legacies and forebodings. In a well-known
definition of policy, public policy is: anything a government chooses to do or
not to do (Dye 1972, p. 2). Policy is about choice: the choice of objectives;
the choice of reasons for (in)action; the choice of policy instruments; the
choice of how to respond to the consequences of policy outputs. These
choices, their consequences and subsequent choices unfold in a temporal
process in which uncertainty is a defining feature.
In this book dynamic analysis is not a conceptual framework or theory, nor
is it amenable to a precise, pithy definition that allows a succession of
theoretical corollaries in terms of policy dynamics. Rather it is a perspective
or a way of viewing the world more akin to a methodology in the sense of
prompting a series of questions about methods of inquiry than a substantive
theory. The idea of policy dynamics is not original; it is proclaimed in the titles
of Rose (1976), Harrison et al. (1990), and Baumgartner and Jones (2002).
However, the intellectual underpinnings of dynamic analysis remain
unexplored in the policy theory literature. The case for the importance of
understanding policy dynamics in the field of policy studies is put forward in
this chapter. This also gives context to the assessment in later chapters of the
different frameworks, concepts and theories that might be used for the purpose
of dynamic policy analysis.
In exploring the foundations of a social-scientific approach to dynamic
analysis, the issue of history in policy studies ineluctably emerges along with
the broader epistemological question of the relationship between socialscientific explanations and historical explanations. Indeed, this book aims to
make progress on the challenge set out by Pierson (2004, p. 5): The
declaration that history matters is often invoked, but rarely unpacked.
Something similar is repeated in Schwartz (2004), Thelen (2003) and
Mahoney (2003). In alternative terms, Reynolds (1999, p. 277) observes that,
without elaboration, the claim that to be properly understood things must be
considered within their historical context amounts to mundane historicism.
Introduction
TEMPORALITY
There is a distinction between temporality and ordinary, common sense
conceptions of time. Broadly there are two categories of answers to
Heideggers famous question: what is time? The first has time as something
which exists independently of things and events; the second sees time as ideal,
in the sense that things are not temporal without temporal concepts. It is
beyond the scope of this book to investigate this question fully, however for
our purposes an answer does help for the understanding of what is meant by a
dynamic perspective. The assumption in this book is that time is an abstract,
imaginary notion; whereas temporality refers to how we make events or
experiences intelligible in terms of time. Time cannot be separated from
things, events, processes and is inherent in all empirical entities.
This allows two things to be set out immediately. First, any policy choice or
decision depends on knowledge of options and thus the concept of possibility
is fundamental. Next, possibility is inalienably linked to temporality: without
sense of a past, present or a future, the notion of possibility and thus choice
does not make sense. Possibility enters into most social scientific theories,
implicitly or explicitly, by the concept of state space. This is the structured
collection of all the possible momentary states of an individual thing. For
example: consumption and production sets in microeconomics; or the capacity
Introduction
retrospectively, and thus fail one of the defining standards of social science
research.
Unpredictability is not, however, inexplicability; as explanation has the
benefit of hindsight. All the concepts, theories and frameworks of policy
dynamics covered in this book contribute to narrative explanation. Chapter 2
stresses that the notion of possibility, inextricably bound with temporality, is
central to narratives of policy dynamics. Most explanations of evolutionary
events are narrative and share with policy studies a focus on unique sequences
and processes; indeed, the limited applicability of state space indicates the
limit of generalization in policy studies. This is one of the reasons why
evolutionary approaches to policy dynamics are considered in Chapter 4, and
ideas of memory in Chapter 5.
Introduction
impacts. Wanna et al. (2000) discuss how the budget-making process at the
federal level in Australia includes requirements for 5-year fiscal impact
analyses of policy decisions and periodic intergenerational equity reports that
use a 30-year time horizon. The relative magnitudes of the different temporal
processes help in the understanding of which process dominates over a
particular timescale, which can be held stationary, or which might be
averaged. Whilst policy theory discusses time horizons, uses notions of time
consistency when critiquing policy design and contains discussions of term
limits for politicians, there is little systematic analysis of different rhythms,
cycles and process speeds in the policy process.
The notion of different temporal scales further limits the utility of static
analysis. Once time is frozen then it is impossible to observe different
velocities. The idea that what is observed from a snapshot has any relevance at
any time in the future is doubtful because the snapshot picture will change
very quickly when there are a multitude of temporal processes occurring; in
metaphorical terms, taking a snapshot of a kaleidoscope will not have much
value in trying to understand what preceded and succeeded the point at which
the picture was taken.
Another related limitation of static analysis is that it does not allow for the
idea of inertia, a key characteristic of policy change. A static approach
assumes away inertia and resistance once a factor driving change has been
nominated and an outcome position identified, but the dynamics question is:
how do you get from one to the other? What is the resistance involved in terms
of countervailing power, institutional inertia, bureaucratic entrenchment or the
reassertion of old thinking or analysis?
Introduction
10
structured interactionist view, and one that emphasizes its corollary in terms of
the need for dynamic analysis:
policy is more like an endless game of Monopoly than sewing machine repair.
Hence the common complaint that policies never seem to solve anything. The
process of choosing and implementing the means of policy is political and
contentious. The actions we commonly call new policies are really somebodys
next move, and in politics, as in a good game, nobodys move completely
determines anybody elses future move.
Introduction
11
12
label of a policy paradigm is that these are the equivalent of Kuhnian scientific
paradigms in their completeness, internal coherence or resistance to
disconfirming evidence, whereas in Chapter 8 the argument is presented that
this is not always the case.
The emphasis on a multitude of processes at different speeds from a
dynamic perspective complements this multi-level view of policy. Throughout
the book I will use the terminology of events to describe abrupt changes of
things; with more gradual change labelled as a process. A process is of the
form S(t), where t is the temporal identifier or index, and S, the state of a
system. Thus, S varies in accordance with the variation in the temporal
identifier: a dynamic perspective. Following this notation the derivate, dS(t)/dt,
can be interpreted at a specific time as an event, the almost instantaneous
change in system.
The distinction between an event and a process helps avoid the dualism
between policy stability and policy change that sometimes affects policy
studies. From a dynamic perspective it is all change, because even where the
state of the system does not change in type or value, S at t1 is different from S
at t2, and so on. This analysis helps to get us beyond continuity (Streeck and
Thelen 2005) in our thinking about policy development. Instead the notions of
events and processes help decompose sequences of policy development into
temporal parts such as periods, stages, phases, movements or epochs. The
method of periodization raises questions for narrative explanation and the
construction of policy histories: these are dealt with in Chapters 2 and 5.
POLICY AS AN INSTITUTION
Institutions are central to contemporary social science theory. Indeed, an
acceptance of the importance of institutions for social and political
development is one of the few genuine cross-disciplinary agreements. This has
produced a variegated set of institutionalisms (see Hall and Taylor 1996, see
also contributions in Goodin 1998). The attraction of institutions, both to
policymakers and analysts, is that they help give a structure to a world that is
complex and in which there are a multitude of temporal processes underway
at different levels. Institutions are collective constraints; organized patterns of
socially constructed norms or roles with prescribed behaviours expected by
the occupants of these roles, which are created and recreated over time.
Institutions help provide a buffer against the uncertainty of interaction among
policy actors and perturbations external to the policy process. Institutions are
enduring, regular and tend to be difficult to change; as such they provide an
important part of the temporal context of policymakers.
As noted earlier, within the policy system whole there are various
Introduction
13
structures at different scales that act as institutions in shaping agents decisionmaking in the formulation and implementation of policy. These are not
reducible to individual level agents or elements in the policy process.
Examples of such policy institutions are budget rules, policy networks,
standard operating procedures in government departments, and agencies. Most
importantly in terms of understanding policy development, past policy
decisions are institutions in terms of current policy decisions: they act as
structures that can limit or shape current policy options. Institutionalism is an
important way of thinking about policy legacies, how policies accumulate and
gradually institutionalize. The ambition to understand how policy histories
affect policy in the present is what drives this project of dynamic policy
analysis: as Oakeshott says, we do not have a blank sheet of infinite
possibility in a policy area; the options for future policymakers are restricted
by past policy paths.
The conceptual distinction between a policy and an institution is significant;
to conflate the two would blur the object of analysis in policy studies.
Nevertheless, in certain circumstances a policy can act as an institution. As
Pierson (1993, p. 596) states: major public policies also constitute
important rules of the game, influencing the allocation of economic and
political resources, modifying the costs and benefits associated with
alternative political strategies, and consequently altering ensuing political
development.
In Pierson (2004, pp. 15051, 1656) policies are institutions, and although
they are less foundational than formal political institutions they can develop
in a manner complementary to and interlocking with those formal institutions.
Further, the application of the voluminous and important literature on
institutional development to the study of public policy represents a significant
research frontier (p. 165). I agree, and throughout the book will be using
concepts that have been developed for the analysis of institutional dynamics
for the purposes of understanding policy development, such as path
dependency for example, in Chapter 3.
14
Further, the use of narratives in this context, far from being perceived as a
weakness or some lack of analytical capability (as some formal social
scientists maintain), should be viewed as the valid method of inquiry for
answering the questions raised by a dynamic perspective on policy
development. Chapters 3 and 4 assess critically two broad concepts as means
of organizing or structuring policy narratives. Chapter 3 looks at the
increasingly popular notion of path dependency and its application to policy.
What advantages and disadvantages does the concept have in understanding or
explaining chronicles of policy development? Chapter 4 subjects evolutionary
theory to similar scrutiny in a policy development context. On the basis of
these theoretical investigations, Chapter 5 sets out how to structure policy
narratives to explain policy dynamics. The chapter acts as both a summary of
the preceding analysis and a methodological guide for the empirical chapters
that follow: what is a narrative? How do you structure a narrative? How do you
evaluate a structured narrative? What makes it convincing or valid, successful
or true?
Chapters 69 constitute Part II of the book. These are all case studies of
particular policy dynamics. Theodore Lowis venerable, but imperfect, fourfold typology of constituent, redistributive, distributive and regulatory policies
has been used to select the cases. I make no claim that these are in any sense a
representative sample of policy dynamics, only that Lowis typology allows
four different policy contexts to be considered in the book. The EU budget is
an example of a constituent policy in Lowis terms in that it involved the EU
adopting a series of decision rules for subsequent policymaking. Chapter 6 will
consider the structure and history of the EU budget with particular attention to
the development of budget rules and their complex inter-dependency over time,
from the mid-1980s onwards. The EUs Common Agricultural Policy (CAP) is
described as a redistributive policy in Chapter 7, which will outline the
argument that although the CAP has been the subject of five reforms in 18 years
these reforms have for the most part been minor, and the key policy dynamic
that needs explaining is resistance to reform. Chapter 8 looks at UK primary
care between the late 1980s and 1997 as a distributive policy. The GP
fundholding scheme was introduced and repealed within seven years in the
1990s and the case illustrates the dynamics triggered by the collapse of a wellestablished policy paradigm and the subsequent instabilities where a major
reform initiative fails to be institutionalized in the policy system.
Pharmaceutical policy is considered in Chapter 9 as a regulatory policy in
Lowis terms. UK pharmaceutical policy has changed significantly since the
early 1990s, towards an emphasis on controlling NHS demand for medicines.
The policy dynamic is of an increasingly complex policy space with new
initiatives layered onto existing policies, creating new and potentially
contradictory interactions between demand-side and supply-side regulations.
PART I
Theory
18
Theory
19
20
Theory
universal laws that explain human behaviour and the nature of all human
societies.
Of course, few social scientists or historians occupy either of the extreme
stances and the linear continuum acts to allow degrees of separation between
different positions. For example, many historians tend to the idiographic
stance; for example R.G. Collingwood in The Idea of History (1946) argued
that explanation in history requires understanding the intentions of agents,
their motives and the consequences of their actions for future events; it is a
hermeneutic activity. History is a complex and chaotic system. On the other
hand, it is usually sociologists, political scientists or anthropologists who are
sympathetic to the goals of explanation by reference to general mechanisms.
In practice, most nomological adherents believe, like Elster, that although a
fully elaborated (micro-)theory is not necessary for the condition of
intelligibility to be fulfilled, it helps. Indeed, it is true that whenever a microtheory from which the postulated causal link can be derived is available, the
explanandum is, ipso facto, made intelligible. This is where the drive for
generalizations is derived in the social sciences: to establish theories that can
articulate a pattern of intelligibility. The theory is not required to be
deterministic or stochastic, nor does it have to have any predictive power.
Instead, it has to be capable of being used deductively, or more realistically
(but more weakly), abductively. The concept of abduction is closely associated
with philosophical pragmatism in the philosophy of the social sciences, and of
C.S. Pierce in particular. The formal structure of abduction is: D is a collection
of data; H (a hypothesis) would, if true, explain D; no other hypothesis can
explain D as well as H does; therefore H is probably true.
As will be discussed in subsequent chapters, the historical institutionalist
(HI) school is an important and influential body of work about history in the
social sciences, and a source of ideas about dynamics in public policy. In
terms of the continuum, this school of thought can be located on this spectrum
toward, but still some distance from, the nomothetic extreme. For example
Hall (2003, p. 395), in his discussion of systematic process analysis, argues
that: systematic process analysis is an effort to elaborate and assess the
validity of theories capable of explaining a broad class of events or outcomes.
It seeks generalizations that are both more simple and more portable than
those at which historians typically aim. More circumspectly, another leading
figure in the HI school, Paul Pierson (2004, p. 6), holds that: Although
historically orientated scholars are (rightly) sceptical about the prospects for
generating anything like a general theory of politics, most social scientists
remain interested in developing at least limited generalizations arguments
that can travel in some form beyond a specific time and place.
While the linear continuum imagined between the two antithetical extremes
is an appropriate heuristic device for illuminating the idiographic and
21
nomothetic approaches to understanding and explaining historical development, it has significant limitations as a way of informing how we look at
policy histories or policy dynamics. Locating approaches or particular works
on a linear scale implies a fixed point; but while scholars may be at the same
abstract point on the continuum, they may differ significantly with regard to
which aspects of social reality they see as more patterned and able to be
generalized, versus those that are understood as primarily conjunctural or
unpredictable. Further, a position on the continuum may be contingent on a
particular descriptive scale. For example, a study may look at new public
management reforms at a nation state level and generalize in terms of
propositions about Organisation for Economic Co-operation and Development
(OECD) convergence; whilst at the same time explaining reforms in the
particular part of the civil service that deals with hospital management in terms
of a series of case-specific, contextual and unique factors.
Even within the nomothetic disposition of the social sciences, it is not
necessary to assert that all human behaviour is equally amenable to
explanation via nomothetic mechanisms. There may be whole sectors of
human action that are quite conjunctural and in which causality is so complex
and interactive that simplifications of the usual sort employed in socialscientific models are incapable of representing reality. The argument in this
book is that the complexity of government and the interaction of policy
systems are, at one scale of description, examples of these sectors. The
observed pattern of development of a particular policy is unique, and one
cannot construct generalities about it or build models in the sense of providing
explicit and deductively sound statements of theoretical arguments; this is
where policy is understood as a composite variable, as in British healthcare
policy or EU telecommunications policy.
Some argue that the antinomy in the divide between the idiographic and the
nomothetic is entirely false; indeed it is logically untenable and
methodologically impracticable (Bryant 2004, p. 452). In particular, to
conflate generality per se with explanatory power is to misconceive the
function of abstraction, and results in empirical content being sacrificed for the
illusory gains of formal parsimony and general scope; yet equally, to develop
interpretive frameworks without bracing them against some conceptual and
ideal-type heuristics confines analysis to atheoretical descriptions of particular
cases.
For Bryant (2004, p. 455) there are negative implications for accepting the
idiographicnomothetic divide:
Assigning separate and distinct epistemic responsibilities to different disciplines
a descriptive-narrational set for the temporal side of human affairs, and an
explanatory-theoretical responsibility for the structural side is to rend aspects of
22
Theory
social life that are mutually implicated and which, ipso facto, can be understood and
explained only by their relational immanence.
POLICY NARRATIVES
Where does this leave us? The claim is made that policy development is
beyond social-scientific modelling and prediction; this does not require us to
believe that there are no recurring causal tendencies in the processes of policy
development that may be formulated into general mechanisms. The question
remains: what aspects of social and political life are repeatable and
generalizable, and which are unique? The answer to this question is directly
connected with the temporal and spatial perspective adopted for any particular
set of explananda. I argue that at the policy level we cannot predict, either
retrospectively or prospectively, thus we cannot yield mechanisms that provide
intelligibility by deduction from models or theories.
Nevertheless it is possible to generalize, however cautiously or contingently,
and this contributes to the structuring of narratives as a form of explanation.
23
A narrative does more than recount events; it recounts events in a way that
renders them intelligible, thus conveying not just information but also
understanding. They therefore contribute to explanation. The purpose of a
narrative is to render various series of events into an intelligible whole;
viewing policy as a composite entity that endures over a significant duration is
one way of rendering the complex interactions of the policy process
intelligible. A narrative can be broken down into a sequence of events,
processes and tendencies in order that they may be individually explained.
This can sometimes be by reference to general, Elsterian mechanisms deduced
from theoretical or empirical frameworks or non-formal models; in other
cases, metaphors can be used to structure the social environment in which
agents are situated and to provide reasons for action. These may include
general, descriptive categories, concepts or frameworks that can be moved
across time and space and be applied inductively or abductively for the
purpose of narrative explanation.
Any historical narrative must simplify reality to render it intelligible by
designating some elements as salient and omitting many more as not
significant. They must also posit a causal relationship between factors and
events. Even within narrative explanation, models (formal or otherwise) can be
used: at certain times they suggest production relationships, which actors in
the narrative are important, and what the relationship is between their beliefs,
preferences and actions. The point remains that the overall sequence or
narrative is unique; at the level of UK pharmaceutical policy there is no
general class of UK pharmaceutical policies for the particular case to belong
to.
Much of the idiographicnomothetic balance is contingent on the scale of
perspective (both temporal and spatial). It may be valid to run historical
regressions of regime change on percentage of gross domestic product (GDP)
spent to establish general theories that predict with an acceptable degree of
accuracy regime or empire shifts over several centuries. Similarly, general
propositions may be uncovered at the level of welfare state regimes (as in the
body of work inspired by Esping-Anderson 1990) or the field of security
studies (as in Powell and Lake 1999 on UN mobilization of states for
peacekeeping). However, a different scale of perspective is involved when
looking at UK health policy developments over a 20-year period, or a series of
economic policy reforms within a particular governments lifetime. The
contextual moves to the foreground in detailed accounts of policy change over
time; this is the essence of policy studies. Explananda are therefore rich,
detailed and contextual whether they reflect a single case or part-comparative
study. Universal mechanisms of change may exist but they are unlikely to
yield an intelligible account of specific spatio-temporal contexts. Categories
and theories logically cannot take the form of unrestricted universals or of
24
Theory
25
26
Theory
beliefs. Thus the policy process is also about what to intend. Such a
distinction, based on looking at the notion of choice from a dynamic
perspective, has implications for policy studies. Consider the following
hypothetical example: imagine a government who has to decide now whether
to attempt a controversial policy launch in six months time. The policy has
already been designed but the government has to decide now about attempting
the policy launch because now is the time to organize publicity, start playing
the political mood music, lay markers, call in favours and so on, for policies
that may be launched over the next year. The government needs to coordinate
any publicity it organizes now with any later attempt to launch the policy.
Timing is one of the great political skills, and affects the extent to which
policymakers can influence the external environment into which policy qua
action is launched. The mobilization of support for including a problem on the
agenda (prior to launching a policy) is a crucial component of models of
agenda setting that have been increasingly useful and sophisticated since
Baumgartner and Joness (1993) Agendas and Instability in American Politics.
The government needs, above all, to avoid uncoordinated combinations of
actions. It needs to avoid attempting the policy launch without having first
organized the grounds for the agenda a significant political risk or
organizing the agenda for a policy that is not launched, which would make it
look foolish. The government will not decide to attempt the policy launch
without also deciding to organize the agenda for it; and will not decide to
organize the agenda for the policy without deciding to launch it. The
government in question is at present risk-averse: having recently had a difficult
six months in office, it now prefers that, having first refrained from organizing
publicity it will not attempt the policy launch. But in the future, as the memory
of the difficulties fades, and this can be quick, the government may well
become less risk-averse. There is a possibility that a present decision not to
attempt the policy launch might later be abandoned by the government even
if, thanks to that decision, no agenda setting for the launch had been organized
beforehand. There is therefore a risk that a present decision not to attempt the
policy launch might lead to an unpublicized policy launch in the future and
so to a mis-coordination between policy and agenda setting.
The government will have reasons for intending to do A and a separate set
of reasons for doing A. This is not a distinction that I am aware of in the policy
studies literature. There may be different reasons in the separate sets that are a
function of time; their temporality affects how governments make decisions.
In Australia during 2005, there was a protracted and public battle over the
introduction of reforms to the industrial relations system. The Howard
government announced its intention to launch a reform policy in April but the
policy itself was only promulgated in October. The policy dynamics
established from announcing the intention for a policy launch ahead of the
27
policy were manifold, complex and contingent. For example, the absence of
any policy proposals allowed the Australian Council of Trade Unions (ACTU)
and the federal opposition, the Labor Party, to launch an AUS$8million scare
campaign on the reforms. The campaign was initially successful to the extent
that the governments opinion polls were adversely affected, industrial
relations reform dominated domestic politics for extended periods (crowding
out other agenda), and Prime Minister Howard was forced into a series of
public statements and announcements claiming that all the adverse publicity
about the reforms rested on unsubstantiated and misleading assertions about
the impact of what will be in legislation that was still months away from being
written. In December, the government had a reform package enacted because
it enjoyed a majority in the Upper House for the first time in 25 years.
However, the final reform was affected by the promulgation of the intention to
launch a policy well ahead of the policy: the political environment became
more hostile, public opinion was successfully mobilized by appeals to
insecurity in the absence of any policy details, and as a result the Australian
government was forced into a series of concessions to mollify its wavering
backbenchers and placate public opinion. This was a case where the step from
the intention to launch, to the launch itself, was not a straightforward matter
that might be ignored or assumed away in policy analysis.
The dynamic perspective on the policy level of description leads to analysis
of contingent conjunctures as opportunities, strategic actions, beliefs about
links between action and consequence, as well as preference formation and
strategic rationality. To understand and explain the sequence involved in a
policy choice in conditions of uncertainty generated by complexity requires a
structured narrative; formal models of policy choice that posit a coincidence
of self-interest of governments and particular actions are inadequate for
dynamic analysis.
Consider monetary policy in the UK in the 1980s. The Thatcher
administrations prior to 1985 believed that only by hitting the broad money
target could they achieve some further goal that they valued extremely highly
(low inflation). The belief and the desire were announced as a set of targets,
M3, a broad money measure. This though had the effect of making this
measure of broad money behave quite differently; indeed it seemed that the
targeting of this aggregate caused its behaviour to change. Several different
broad money targets were tried, but all proved impossible to control once they
had been targeted. This was memorably summed up in Charles Goodhardts
wallpaper bubble principle. If the government had cared less about hitting the
target, they might have succeeded more easily that is, they might have been
able to act in order to control it. The intention to hit the target had a series of
complex consequences for action, consequences and beliefs about the
relationship between actions and outcomes. Indeed, even as the professed
28
Theory
monetary targets had been overshot and changed many times, the economy
had been tightly even excessively squeezed, sterling rose strongly,
unemployment soared and inflation plummeted. Inflation was, for the
Conservative administrations of the 1980s, their judge and jury. The
targeting of the money supply was formally abandoned in the UK in 1985, to
be replaced by Chancellor Lawsons interest in fixed-exchange-rate regimes as
guarantors of low inflation.
It is possible to render this complex series of actions, consequences and
conjunctural contingencies intelligible in terms of a concept like monetary
policy, as in Kenway (1993) for example. As social scientists, we wish to add
something to the narrative by way of structure using portable and general
concepts, theories, metaphors and mechanisms. The methodology of
structured narratives is deferred until Chapter 5, for now we note the problems
of the general and the universal for issues of portability. This question is
highlighted here as the next two chapters look at two broad groups of
metaphors, theories and mechanisms that have the potential to be portable
across time and place in supporting structured narratives of policy dynamics:
path dependency (Chapter 3) and evolutionary theory (Chapter 4).
The general and the universal should be clearly distinguished: to make a
generalization is not to claim that the phenomenon or process occurs
frequently or in a large or universal range of cases; Goldstone (1998, p. 832)
argues that:
A general law is not general because it applies to a wide variety of different kinds
of cases and events what makes a general law general is that it applies to a
range of initial conditions and asserts a necessary or probable connection between
particular initial conditions and a subsequent event or events.
3. Path dependency
The emergence of a new institutionalism across the social sciences has
coincided with the increased interest in temporality, change and history in
social and political analysis. Institutions are structures that trace a path
through state space; they endure, have a history and can be used to link
temporally events and processes. The concept of path dependency has been
used within political science almost exclusively within a broad institutionalist
framework. It is institutions that are path dependent; as Raadschelders (1998,
p. 569) states: whatever the discipline contemporary neo-institutional
analysis has one feature in common: the notion of path dependency. The
widespread and cross-disciplinary use of path dependency for the analysis of
institutional stickiness makes the concept an obvious starting point for the
examination of concepts, metaphors and theories that might be used to
structure narratives of policy dynamics.
Indeed, the concept appeals as a label for the simplest of policy dynamics:
that past policy decisions act as a constraint on the options available to current
policymakers; or to use the language of dynamics from Chapter 1, that past
policy decisions act to circumscribe or foreclose parts of policy space. This
basic dynamic raises the question of how robust paths are over time and
through changes in the policy environment, and supports the interest in
evolutionary thinking developed in Chapter 4. Further, the refinement of the
concept of path dependency in response to complaints of determinism and an
inability to accommodate change introduces the discussion of the
methodology of structuring narratives of policy dynamics, which is set out
more fully in Chapter 5.
A process is path dependent if initial moves in one direction elicit further
moves in that same direction; in other words, the order in which things happen
affects how they happen: the trajectory of change up to a certain point
constrains the trajectory after that point. As Douglass North (1990, pp. 989)
puts it, path dependency is a process that constrains future choice sets: At
every step along the way there are choices political and economic that
provide real alternatives. Path dependence is a way to narrow conceptually
the choice set and link decision-making through time. It is not a story of
inevitability in which the past neatly predicts the future.
The reference to choice sets and decision-making reveals the origins of the
concept in economics. Indeed, path dependency is problematic for that
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Path dependency
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Path dependency
33
in the social housing sector and ensure equity between local authorities and
housing associations. This particular element of social housing policy is path
dependent; each local authority has an established policy for rent calculation,
often determined by initial decisions made in the immediate post-war era. That
these have proved resistant to central control or influence significantly
constrains the ability of central government to pursue some of its objectives
for social housing. However over the same period as this path-dependent
process, there has been a clear shift in the social housing policy paradigm. One
of the five pillars of the UK welfare state has been, to a large extent,
removed. Between 1971 and 2002 home ownership increased from 49 per cent
to 69 per cent, with most of the increase occurring in the 1980s. The right to
buy scheme introduced in the early 1980s contributed to the increase in home
ownership, as it allowed local authority tenants to buy their own home.
Corresponding to this, the percentage of householders renting council homes
increased from 31 per cent in 1971 to 34 per cent in 1981, but then gradually
declined during the 1980s to 24 per cent in 1991. This percentage has
continued to decrease and in 2002 14 per cent of all householders rented from
the council.
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Theory
provide necessary and sufficient conditions for the process observed. The
challenge for the use of path dependency in helping to structure narratives of
policy dynamics is the uncovering of mechanisms that can help make sense of
a path-dependent process. One influential strand of the literature on path
dependency has worked on the microfoundations of the concept using insights
from new institutional economics. Much of this literature, particularly by
US-based scholars, proceeds by analogy from technological development to
institutional development. In simple terms, imagine two technologies, A and
B, both of which are subject to increasing returns but there is uncertainty over
the rate of increasing returns. Initial adoptions of one technology, say B, that
may occur for a number of small or chance reasons, beget further adoptions of
B in the market because of increasing returns that is, it becomes cheaper for
future firms to adopt technology B rather than A. The interesting results from
the models built on these assumptions (for economists at least) are that you
might get inefficient technologies adopted by markets. The normative
implications of this borrowing from economics are considered in more detail
later.
Arthur (1994) states the circumstances in which path dependence as an
increasing returns process is likely: the presence of large fixed (and sunk)
costs; network effects; learning effects; and adaptive expectations. As noted,
these factors have been used at a macro, constitutional level to make
arguments about path dependency in institutional development (North 1990;
Pierson 2000a, b, c). Within this list of sources of increasing returns, it is
useful to distinguish between those factors that relate to the internal efficiency
of firms large fixed costs leading to declining average costs as production
increases and learning takes effect from those that are external to the firm;
in particular, network effects. The distinction is important because later in the
chapter path dependency is discussed in terms of the increasing returns
involved in combinations of institutions and policies, rather than increasing
returns as a property of the internal operations of firms. This complements the
insistence on a fine-grained perspective of policy systems developed in this
chapter.
A focus on increasing returns is only a partial interpretation of the
economics of path dependency. Increasing returns are sufficient but not
necessary for path dependency. As Arrow (2000) points out, the existence of
significant sunk costs along with sequencing arguments can support many of
the path dependency narratives of technological change. Although he does not
use the concept of path dependency, Arthur Stinchcombes (1968, Chapter 5)
celebrated work on constructing theories of historical causation emphasizes
the central importance of sunk costs. I submit that any decision that is difficult
to reverse and which has enduring and ongoing effects can be said to have
initiated a path-dependent process; and work on path-dependent processes
Path dependency
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Theory
Path dependency
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Theory
Kemp (2001) with respect to housing benefit reform in the UK; Pemberton
(2003) with regard to pensions; and Greener (2002) on the NHS. Each of these
studies finds path dependency in policy development alongside some policy
change. They consider change as a reaction to the unintended consequences or
side effects of policy, or from pressure for reform due to exogenous shifts in
the wider policy environment: for example, where the distribution of power
between interested groups has changed. Once a dualism between policy
stability and policy change is established, the notion of path dependency is
only useful for accounting for the former; indeed the purpose of the concept is
to aid understanding of policy stickiness and why actors do not change policy
across time.
However, the dualism between stability and change can be avoided by
considering the sedimentation of policy decisions or the growing complexity
of policy space that is implied by the notion of path dependency. The dynamics
of policy subsystem accumulation are theoretically underdeveloped but are
important for the use of path dependency in policy narratives. As discussed in
Chapter 9, the development of UK pharmaceutical policy since the 1980s
provides an example of new policies being added on as a patch or fix to
satisfy pressure to mitigate the consequences of the original policy. Relatively
high prices for medicines were agreed by the government to reward innovation
by the industry under the Pharmaceutical Price Regulation Scheme (PPRS);
this contributed to the rapid increases in public expenditure on medicines,
observed since the late 1980s. The PPRS remains unchanged and potentially
path dependent but its budgetary consequences have precipitated a series of
new policies aimed at controlling the demand for medicines in the NHS, such
as cash-limited prescribing budgets. The path dependency of a particular
policy subsystem is a contributory factor in the explanation of the
accumulation of these policy patches and the growing complexity of the policy
system, with potential consequences for the overall coherence and
effectiveness of policy.
To reprise, a key issue when using the concept of path dependency is the
granularity of the perspective. Much of the work within the HI literature uses
the concept at a macro-perspective, in which there is a single whole that allows
for discussion of an institutional setting or a policy. The path then refers to
the trajectory for that composite variable, the direction of which is reinforced
after early moves in the sequence. Whilst this is valid for some narratives, from
a more fine-grained perspective the issue is which elements of that composite
system are fixed or locked-in, and which are capable of being reformed.
Further, within the policy space occupied by the composite whole there may
be potential for the introduction of new institutions or policy subsystems.
Crucial to my analysis of the development of the EU budget system in
Chapter 6 are the incompleteness and limitations of the initial Treaty-based
Path dependency
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Theory
The relatively informal models offered by Crouch and Farrell (2004) are
designed to address the apparent determinism of path dependency once a path
is selected. Change is explicitly modelled as the intentional adaptation of
agents to exogenous, environmental shifts. The emphasis is on the ability of
agents to reactivate redundant institutions, or convert existing institutions to
different purposes, or borrow wholly new institutions from elsewhere to tackle
exigencies. These models also prompt thinking about what has been called the
layering of institutions; in terms of policy the implication of this notion is
that at the level of the composite whole, policy systems cease to embody a
simple unique logic, but rather a complex bundle of different policy logics,
ideas and interests. Some of these may be dormant, unused or forgotten for
periods but are capable of being reactivated by strategic action by agents in
response to exogenous environmental shifts. Institutional layering is
considered in more detail in Chapter 6 on the EU budget.
The reassertion of the capacity of agents situated within path-dependent
processes, with increasing returns acting to change the direction of the path in
response to shifts in their environment, is important for how we structure
policy narratives; indeed, it contributes to my argument for methodological
localism as the appropriate foundation for a methodology of policy dynamics
in Chapter 5. Inheritance and policy legacies are not as hard or fixed or as
determined as some of the simple path dependency analysis may suggest; for
example, increasing returns processes in economics typically assume a static
environment, whereas changes in that environment can attenuate (or amplify)
feedback processes. In providing a set of mechanisms that may help to
structure a narrative in terms of transitions between paths, Crouch and Farrell
(2004) provide a service to the analysis of policy dynamics. This can
complement the emphasis on inter-policy and inter-institutional relationships,
in particular combinational effects, which imply that policy development
proceeds in a more subtle way than the two-speed view of policy development.
Normative Aspects of the Term
One of the consequences of constructing the explanatory foundations of path
dependency in public policy by analogy from the economics of technological
development is to import the normative result that inefficiencies can persist
in path-dependent processes. This is a powerful result for neo-classical
economics: certain historical factors can ensure that inefficiencies occur and
markets do not eliminate these over time. Efficiency is understood here as
social efficiency, that is, a situation where both technical and allocative
efficiency hold. The strength of this normative result depends on the
judgement as to whether the inefficiency could have been foreseen at some
point in the initial stages in the path-dependent process and corrected; and
Path dependency
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4. Evolutionary perspectives
Although the terms evolution and evolutionary are widely used in the social
sciences, for the most part they are employed as convenient shorthand for slow
and gradual change over time. This chapter considers evolution in a more
substantive way; investigating the prospects for evolutionary theory
contributing to the ambition for more fully developed dynamic perspectives on
policy change.
The first section of the chapter will establish the distinction between
evolution as a process of change and evolution as a theory of change. This
distinction is a necessary start to understanding the terms on which one may
judge the added value of an evolutionary perspective to existing accounts of
the dynamics of public policy. Importantly, the distinction is relevant to the
following commonplace and important objection to evolutionary approaches
in the social sciences: that biological analogies in the social world are weak,
that there are no equivalents of natural selection operating in the social world
and that without selection, evolutionary theory has little explanatory power in
the social world. This is also known as the missing mechanism argument.
We can employ a two-part strategy to address this problem. The first part is
to understand evolutionary theory as a (realist) ontological proposition that is
valid for the analysis of the evolution of all open, complex systems including
natural ones (Campbell 1965). The next part argues that the correct analogy to
consider is not that between the natural and social worlds, but rather the
analogy between the problems of evolutionary theory in explaining natural
processes of change, and the problems of evolutionary theory in explaining
processes of social change in terms of issues such as time, history and
differential rates of change. It is from this analogy that policy studies can learn
from and adapt evolutionary theory for the purpose of understanding and
explaining dynamic processes of policy change. Indeed, the weaknesses of
adaptionist models in evolutionary biology provide further intellectual succour
for the narrative approach by buttressing the argument that relying on thick,
contextual and historical description structured by general concepts or
portable metaphors is not a failure of formal modelling, but rather the
appropriate response to what cannot be formalized into a model; nor is it
amenable to explanation by a general testable theory.
Section two considers the main arguments for scepticism about the value of
evolutionary theorizing in public policy. First, the close connection with
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Evolutionary perspectives
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Theory
Evolutionary perspectives
45
constituent elements with feedback (both positive and negative) and agents
capable of innovation, there is the possibility that internal order of a system
can increase, or self-organization can occur typically leading to emergent
properties independent of external selection pressures. If we admit such a
possibility then the perspective of evolution as a process moves away from
approximating the organism as the sum of independent genes, or policy as the
sum of independent actions by policymakers. Kauffman (1995) uses the idea
of complexity to doubt gradualism in evolutionary processes in the natural
world by establishing that in some complex systems any minor mutation
causes significant changes in the system due to interaction effects. The
influence of Kauffmans work is manifest in Robert Jerviss (1997) System
Effects: Complexity in Political and Social Life about international politics
(see for example pp. 13, 41, 48, 157).
Much of the recent work in evolutionary economics is also in this vein
(Potts 2000; Foster 1997); concerned with self-organization, how patterns of
collaboration and cooperation can emerge quickly out of the interactions of
agents within certain complex systems. The point for us here is that interaction
and relations among agents can make the whole (policy, for example) more
than the sum of its parts. The interactions and relationships in a policy system
form institutions, generate variety, and produce complexity in the interaction
of ideas, interests and material circumstances. This makes composition
important: these relations cannot simply be summed; rather they are dynamic,
complex and typically have emergent, self-organizing properties.
This challenge to reductionism should be distinguished from the emphasis
in much neo-institutional analysis on strategic agency and the need for firm
microfoundations for theories of institutional change. This is driven by a
proper concern that institutional analysis should not overdetermine
behaviour or actions; that the potential for creative, innovative and
entrepreneurial agency means institutions cannot explain uniquely, nor can
they be assumed to persist indefinitely. I accept this without hesitation; my
argument here, developed more fully in Chapter 5 on the methodology of
structuring policy narratives, is that this should not be taken as methodological
individualism. By always focusing on the individual agent and how their
decision-making is affected by institutional structure, evolutionary effects in
terms of the emergent properties of composite wholes are liable to be missed.
Institutions are collective: it is groups of agents following a rule that
constitutes an institution. Significant interaction effects include tipping points,
network effects, combinational effects, bandwagon effects, reinforcement,
emergence, learning and imitation. These are all concepts from the evolution
of complex systems that can be used to structure narratives of policy
dynamics.
Further, by acknowledging that there are properties of the whole that are not
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Theory
reducible to its constituent elements, the analytical possibility of macroevolutionary effects is raised. This is where the causal mechanism runs from
macro-level to macro-level. For policy purposes, this means causal links at a
level higher than individual agency; as in situations where policies can cause
policy change, or policy institutions can cause institutional change. An
example would be policy reform packages; the Australian governments
decision to introduce a broad-based consumption tax, the Goods and Services
Tax (GST), in 1999 after 30 years of protracted and deadlocked political
debates over tax reform, caused other policy changes inter alia with:
intergovernmental fiscal relationships in Australia; small business support
schemes; and personal private investment policy.
The purpose of discussing evolution as a process is to establish first that the
explanandum of evolutionary theory is not just gradual change; and that looser
use of the term evolution misses a substantial part of the process of
evolutionary change that of as rapid bursts followed by periods of stability.
There are no analytical advantages to making an a priori assumption that
characterizes change as gradual or rapid; cumulative or equilibrating;
directional or non-directional; ergodic or nonergodic. Second, that viewing
evolution as a complex process with potential system effects renders the
gradualismreductionism analytical strategy invalid in evolutionary theory.
There are institution-to-institution causal links and policy-to-policy
production effects that cannot be reduced to individual agents and their
decisions. Instead the relationship is captured by the philosophers concept of
supervenience; Chapter 5 takes this point further.
Evolution as Theory
Any evolutionary theory supports a form of consequence explanation; social
phenomena are explained through their actual consequences. The central task
for an evolutionary theory supporting explanation-by-consequences is to
provide a mechanism by which the consequences uphold or maintain the
action or structure that one wants to explain. In the absence of some kind of
feedback from effect to cause, explanation by consequence remains unclear. A
functional explanation (FE) is a special class of consequence explanation
where the consequences of an institution or routine of behaviour are
favourable, or functional, for some agent or group who maintain that
institution or behaviour. Explaining why an institution emerges in terms of
its consequences reverses the temporal sequence of causes preceding
consequences. Thus it is highly problematic in a obvious sense that it is
metaphysically impossible for an event to be explained by another event that
occurs at a later time.
Usually the answer is to emphasize historical contingency, accident or
Evolutionary perspectives
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48
Theory
universal is that their instantiation in the social world need not be directly
analogous to genetic variation and selection.
The nature of ontological reasoning is notoriously elusive and, from a
policy studies viewpoint, prone to arcane abstraction. Nevertheless, the claim
here is problematic: what is the relationship of these general evolutionary
principles to some acceptable theoretical presuppositions about the policy
world, or empirically based understandings of policymaking? If the principles
of Universal Darwinism exist as logical possibilities in complex mathematical
models, what is the status of evolutionary theory in the social world? At least
formal models in economics are traceable back to assumptions about
economic behaviour. What would the patterns and predictions of complex
systems models mean in terms of explaining a policy process? In the terms that
have been used in this book the question can be rephrased as: does
evolutionary theory assist in providing intelligible mechanisms to link steps in
a narrative?
I will leave this question open for the moment but note that in accepting the
ontological claim that social systems are subject to evolutionary principles, the
ground by which to judge the validity or usefulness of evolutionary theory is
shifted. This does not of course avoid the missing mechanisms argument, but
rather changes its nature. The challenge is no longer to uncover a mechanism
of selection that is the equivalent of genetic selection in the natural world,
because the argument no longer proceeds by analogy from the natural to the
social world; instead the ontological assumption requires a search for
mechanisms of variation, retention and selection that are appropriate and
contextualized in the social world. The missing mechanism need not be
analogous to genetic selection, but it remains missing nevertheless. It is to this
challenge that the next section proceeds.
Evolutionary perspectives
49
In any given item of functional analysis, there are two groups of individuals
involved: those who engage in the practices to be explained and those who
benefit from these practices; that is, those for whom they are in some sense
functional. The question of intention arises only for the first group; the
question of recognition may arise for both. The two groups may coincide,
overlap or be totally separate. In the latter case, the possibility arises that the
effects are unintended by those who produce them but recognized by those
who benefit from them. However, identifying actors and beneficiaries is not
sufficient for an explanation of change. For example, in order to see how a
dysfunction can explain change, it is necessary that the victims need not only
perceive the problem but also correctly identify its cause. If the dysfunction is
not recognized, then the victims cannot act as a causal agent in social change.
Moreover, when the outcome but not the cause of a dysfunction is perceived,
as is often the case if the causal chains are protracted or complex, no pressure
for change should be expected; or, if there is pressure for change, it should not
be expected to be successful in doing away with the problem. Without the
agential link between consequences and future action, or an equivalent of
natural selection in the social sciences, then FEs are weak and rightly to be
avoided in the social science field. This is our preceding discussion: natural
selection supports FEs in the biological sciences, but without an equivalent
in the social world evolutionary theory cannot support FEs in the social
sciences.
What are the prospects for evolutionary theories having explanatory power
without functionalism? This requires the starting assumption that general
evolutionary principles operate, but not in a way that selects behaviours or
institutions that produce favourable consequences for some group or agent, as
that would amount to functionalism. This is the dilemma of wanting
evolutionary theory to have some explanatory power whilst avoiding
functionalism. Kerr (2002) asserts that institutions, behaviours or ideas that
have consequences that are beyond the strict limits or selective pressures
set by the environment, will not tend to occur; and this forces individual
actors or groups of agents to negotiate, and adapt to, the context in which
they are situated (p. 351).
His basic argument is that because dysfunctional elements tend to
disappear, persisting forms can be assumed to be adapted in the sense of not
being dysfunctional. It amounts essentially to the assertion that nondysfunctional institutions maintain themselves over time, because they do not
transgress environmental limits or constraints. Some might see this position as
vulnerable because there may be many non-dysfunctional alternatives to a
given dysfunctional institution. Without the ability to say which of them will
emerge and at what time, rather than simply that one of them ultimately will,
the predictive capacity of evolutionary theory is limited. This brings us back
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Evolutionary perspectives
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Evolutionary perspectives
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Evolutionary perspectives
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Theory
demand and supply; but most economic textbooks assume that prices will
adjust, just as most evolutionary biology textbooks assume that evolution has
occurred. This may be an appropriate modelling device for certain purposes,
but for the dynamic analysis of actual processes of change, evolutionary theory
in biology must rely on structured narratives.
The evolutionary approach in policy studies shares this characteristic with
evolutionary biology. This is an important element in the value-added of
evolutionary theory for understanding policy dynamics by showing that
dynamic analysis in different fields favours narratives. In adopting a detailed,
contextual scale of description of individual policy development, policy
studies rely on narrative for explanation where mechanisms are expressed as
tendencies, dispositions and environmental limits combined with an emphasis
on conjunctural contingency, memory and history. The evolutionary approach,
while not at all ruling out intentional explanation and strategic agency,
certainly decentres the agent in the policy process; the metaphor puts selforganization and selection mechanisms alongside intentional action in
structuring narratives. Further, the evolutionary metaphor helps to introduce
policy learning in a constructivist sense, which is useful for understanding the
emergence and institutionalization of policy paradigms.
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Theory
61
create for agents within those settings; and construct explanations of outcomes
that link the causal properties of those structures to the processes of
development that are found in the historical record.
A policy path encompasses a series of steps in the development of policy
that are explained individually: there will be different explanations for
different steps in the sequence as there is no single causal mechanism to
encompass the whole policy narrative, nor is there a teleology or historicist
cause from which all else can be traced. These steps may be moments, events,
processes, periods, choices that are observed more generally, or are a typical
kind for which we might employ portable concepts, models or metaphors;
alternatively these may be salient events these are not necessarily large or
immediately recognizable, but are capable of being labelled in retrospect as
critical junctures in the development of a policy.
Pierson (2004) stresses that causes have their effects over different temporal
scales; just as the historian is counselled by the Mao Tse Tung view that the
twentieth century was too early to tell about the effects of the French
revolution. It is only by virtue of hindsight that one can judge salience;
additionally, different events acquire salience over time that is, our
judgement of salience is itself temporally distinct. The judgement of salience
relies on questions of potentiality and contingency: if possibilities are
foreclosed by a decision or action, or when the costs of reversing a decision or
action are high, this is a condition for salience. However it is not sufficient, as
there must be a supporting judgement that the decision or action had
significant or meaningful consequences in terms of policy development.
Unlike closed systems studied in theoretical models based on the ambition for
covering law explanations, policy processes sit in an open context. This is
what makes theories of the policy process so difficult: they are irreducibly
complex. This is a common predicament for professional historians; the
crossing of many causal paths drives events. Many of the steps in a structured
narrative occur at the nexus of contending forces. John Bury (quoted in
Oakeshott 1966, p. 201) argued that this confluence of paths was not governed
by laws and stressed the idea of contingency in historical analysis: it was the
conflux of coincidence that proved decisive.
In terms of narrative as a form of explanation, the key for any narrative is to
avoid being a Just So story. Such stories refer to Kiplings answer to how the
leopard got its spots and the rhino its wrinkled skin; because of the fanciful
natural history in these stories, the term came to be used in evolutionary
biology to refer to unnecessarily elaborate and speculative evolutionary
explanations that lacked any substantial empirical support. The term has come
to be used in the social sciences in the same way. In historical narratives,
theoretical models are used but they are local or contextual, and sometimes
limited to one specific, temporally distinct event within the narrative. Theory
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In these terms, the model defines what is important in the narrative and thus
avoids the problem of ad hoc-ness that inductive narrative explanations, from
a social science perspective, may suffer from. However, the evidence that suits
the testing of the model is selected, which raises the possibility that the model
is true or correct in terms of confirming evidence, but inadequate in terms of
understanding or making sense of the overall phenomenon. In John Godfrey
Saxes fable of the six blind men confronting an elephant and touching
different parts of the animal, each of their different models was correct and
confirmed by the evidence from touching the elephant: an elephant was like a
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wall, a sharp spear, a huge fan, a giant snake, an old rope and an extremely
large cow. However, none of these models was remotely adequate for
characterizing an elephant.
From a dynamics point of view, the contextual elements of the narrative are
essential for making sense of the development of a complex, composite
variable over time. The thick, historical description, the emphasis on
conjunctural contingencies and strategic agency are the core elements of a
narrative; this is what needs to be made sense of rather than being stripped out
in the interests of lean modelling. Bthe (2002) is encouraging the analyst to
make the overall evidence subordinate to the theory (as expressed in the
model). We reject here the notion that narratives should be conceived as
testing the model, on the grounds that to do so would inevitably render the
narrative a just so story where features of the world that are essential and
causal in this context are ignored because they do not have, nor could they
have, a place in the general model because of the irreducible complexity that
characterizes policy processes.
In place of the goal of assisting the discovery-governing regularities by
testing models of general theories, the function of the narrative in policy
studies is to provide understanding and explanation of particular dynamics of
policy development. Because of contingency and the importance of possibility
in policy dynamics, there is no way to tell the trajectory or path of a policy
except by following it step by step. There is no covering law to be unveiled
here. When the contingent causal factors at one step are understood, then we
cannot call upon a dynamic rule to deduce what happens next; no such rule (or
theory or model) exists. Many causal factors pull and tug in different
directions in a historical process, and the policy analyst must compound them
in order to understand the process (it is not possible to strip them away into
component parts or use the ceteris paribus method). Complex systems
textbooks show the vast intellectual effort necessary to compound causes in a
theoretical model to deduce the progress of relatively simple systems; this
reveals the hopelessness of models aggregating micro-causes in complex and
heterogeneous policy systems.
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to us that such actions should make sense to the agents in those circumstances.
If an agent acts for certain reasons, observers can be in a position to make
sense of that action in terms of those reasons. One way scholars can do this is
by thinking himself or herself into the position of the agent (their context,
outlook, preconceptions and memory). This deeply contextual form of
historical understanding was emphasized most famously in the works of R.G.
Collingwood (for example, Collingwood 1946).
This concern for the intentions and beliefs of agents has implications for the
research methods of policy dynamics. Direct evidence of mental states in
terms of interviews or other documentary evidence is a key aspect of analysing
choice; the tendency in some rational choice history (see Elster 2000, p. 693)
is to impute intentions and beliefs in order to explain actions. The interpretivist
approach holds that it is poor social science to construct a model in which
observed behaviour maximizes the interests of agents, and then assume that fit
between the interest and the behaviour explains the behaviour. It may just be
a coincidence; and this is where the historical form of understanding set out by
Collingwood can add such great value to policy narratives.
It is important to note what the interpretivist approach does not imply: it does
not mean that the observer identifies themselves with those reasons, or would
have acted similarly. Rather this refers to a feigned understanding of
the agent. Further, putting oneself in anothers shoes may provide an explanation
or understanding of the action observed, but it may not provide
the complete or adequate explanation. There are important social, psychological
and political questions that arise in why the agent should act on such reasons.
This detailed study of the context in which the agent is situated including the
actions or anticipated actions of others complements the analysis of the
motives and intentions of agents in narratives of policy development.
Neo-institutionalism tends to stress the importance of how agents construct
internally institutional constraints, and how they constitute themselves within
these institutional structures. This is how institutions constrain: it is only
through affecting the intentions of agents that institutions have any causal role
in explaining behaviour, including those behaviours that result in institutional
change. Fisher (2003, p. 28) summarizes the position:
It is not that institutions cause political action; rather, it is their discursive practices
that shape the behaviours of actors who do. Supplying them with regularised
behavioural rules, standards of assessment, and emotive commitments, institutions
influence political actors by structuring or shaping the political and social
interpretations of the problems they have to deal with and by limiting the choice of
policy solutions that might be implemented.
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Theory
question for policy studies, given our continued emphasis on the complexity
of inter-agent dynamics in the policy process.
The notion of situated agency has a strong role in the scheme for policy
narratives in allowing agential space to make choices within institutional
contexts; and the capacity to innovate to make and remake institutions. But
this focus should not be at the expense of acknowledging institutions as
collective actions, choices or interpretations. How can groups of agents change
their institutional environment? This is a collective choice; and therefore
talking about agents choice within institutions is to miss much of the
dynamics at work around bandwagons, tipping points, threshold effects,
sufficiency parameters, and so on. Structured narratives of policy dynamics,
within a presumption that situated agents are the units of analysis, should be
cognisant of these emergent properties of relational dynamics.
Policy Memory
In a general sense, memory refers to the capacity for remembering, recalling,
recollecting or recognizing. The extent to which events, behaviours, routines
and institutions are remembered is an important, and relatively neglected, part
of policy dynamics. Memory is a mechanism that links past events and current
intentions, actions and behaviour. It is a function of time: it is always the
memory at a given moment in time of an event that occurred at some previous
moment in time. This is an important point for any dynamic analysis; policies
and institutions are reproduced and have local states at particular places and
particular times.
The idea of memory is well established in systems analysis. Cortes et al.
(1974, p. 3) define it as the impact of some event that happened in the past
upon the current response of the system. Memory is strongly related to the
concept of hysteresis that was first introduced into economics by GeorgescuRoegen (1967, 1971) in the study of consumer behaviour: individual utility at
a point of time is not simply a function of consumption at that time; rather it
is affected by the past consumption of that individual as well. It has
subsequently been used in a number of different economic applications,
perhaps most prominently in the idea that there is a mechanism whereby a rise
in unemployment increases the equilibrium (or natural rate) of unemployment.
Elster (1976) uses the notion of hysteresis more generally in the analysis of
social and political change, but the term memory is preferred here in order to
adumbrate the memory of individual agents as the object of interest.
Brain scientists and philosophers of the mind are a long way off being able
to predict what gets remembered and being able to explain why. In light of
this, the description of the policy memory mechanism here is appropriately
basic and focuses on two different aspects of memory. The first aspect is
69
70
Theory
71
How then does a change in a policy paradigm come about? Because the
following of institutional rules is second nature, the rules themselves are
potentially recoverable by consciousness and it is this potential recoverability
that explains institutional change. In other words, institutional change results
when agents come to have reason to direct their consciousness at what has
become second nature. This reason may be shifts in the external policy
environment, new ideas, or the accumulation of feedback on the consequences
of the policy paradigm.
This notion of change bears a strong resemblance to John Deweys work on
habits and intelligence (Dewey 1922). For Dewey, awareness of the existence
of a particular institutional rule emerges, as it were, from the background to
the foreground of consciousness. It is at this point that intentional human
agency holds out the possibility of innovative and creative institutional change.
A strategic and conscious element enters into habitual action; although the
habitus or background may predispose agents to act in particular ways, it does
not reduce them to cultural dopes or inhibit their strategic capacities.
It is important to point out that for a particular policy paradigm to fade and,
hence, for institutional change to occur, it is not enough that a single agent
comes to recover into consciousness the rule and stop behaving in accordance
with it. Rather, the population of agents to which the rule applies must,
collectively, stop behaving in accordance with the rule. Of course, if an agent
that is pivotal to the institution, or perhaps society more generally, either
declares that people should no longer behave in accordance with a particular
institutional rule, or stops herself behaving in accordance with that rule, then
this can induce the collective intentionality required for institutional change.
However, even in this case, the collective intentionality is a necessary
condition for change. Thus, although the potential recoverability into
consciousness of institutional rules that have become second nature helps to
explain the potential for institutional change, the need for collective
intentionality to actually institute that change helps contribute to institutional
stability over, possibly long, periods of time.
EVALUATING NARRATIVES
A narrative is a selection of elements such as events, steps and processes from
a chronicle; the long sequence of things that happened, which can be
organized by some interpretive frame to make sense as an overall story. The
narrative has to make sense to at least the person who made the selection, so
is not entirely arbitrary in the manner suggested by a strong reading of the Dr
Seuss imputation of ad-hocness. Further, just like professional historians,
policy scholars are concerned with the discovery, validity and reliability of
72
Theory
evidence. Thus, in terms of selecting items for narratives there can be some
agreement on the basic facts of policy development, or in the terms here, the
chronicle on which the narrative draws. But crucially, there can be agreement
on facts but substantial disagreement on what makes sense of them to different
people. Very different narratives are possible, and indeed it may be that
whichever group or individual has the power over the writing of the narrative
determines what is accepted as making sense. This is what motivates the
reluctance of some to use narratives; they are always extemporized and
should be regarded as data sets upon which to trial different models of policy
change.
Indeed, it is difficult to produce an objective standard or set of criteria
against which to assess or test the validity of a narrative explanation. One
response is to stress the competition between different narratives, different
interpretations and different explanations of the same thing, and argue that this
competition may advance the literature toward something that is a better
explanation or perhaps closer to the truth. Williams (2002, p. 252) puts it in
terms of the marketplace of ideas: Continued inquiry eliminates earlier
interpretations, which become, in the face of further information and more
searching questions, indefensible. This is particularly pertinent for the
analysis of policy dynamics, which is history that ends in the present or near
past. New evidence of the consequences of policy decisions or of certain
actions emerges constantly.
Additionally, the policies themselves are the subject of continued political
contestation. For example, subsequent policy development can give new
meaning to the preceding policy history: does this policy mark an aberration
or permanent shift in direction? Can you see permanent interests in a policy,
beyond those produced by specific periods of electoral competition? Has
interest group power been realigned? Has a certain policy idea become
institutionally embedded, or is its influence more parlous? Is this policy
change an ephemeral response to short-term events, or something that is path
dependent? New evidence on questions of these types will confront the student
of policy dynamics at a rate that alleviates some of the difficulties that
confronted historians of the far past and increase the competition between
existing narrative explanations. The constant possibility of new disconfirming
evidence will, by one view, intensify the competition among different
narratives. This yardstick criteria of a successful narrative it is better than the
alternatives in explaining the evidence is similar to the abductive reasoning
emphasized by Pierce and other American pragmatists.
An alternative response to the challenge for criteria to assess the value of
narratives is to accept that there are variations in what makes sense to different
people (either at the same or different times). This invites the label relativist
and it is important for my argument to explore what this might mean here. The
73
first point, for philosophers, is that the position is not relative to the truth.
There are historical facts in policy development: this legislation was enacted
on this date; the budget for 2004 allocated 10 million for this; the leader of
the Greens said this on this date, and so on. Relative, rather, refers to the
judgement involved in selecting from the chronicle the material to form the
narrative and the use of different concepts, metaphors or models to provide
intelligible mechanisms in the narrative. Different scholars may argue
different interpretations or use different metaphors or concepts, and may
contest other scholars judgements. There are different disciplines with
different standards of justification, and different standards for explanations: a
belief in causal explanation does not provide a unique or universal method of
justifying different causal explanations.
By denying a universal standard, Rorty (1982, p. 166) argues, does not have
the corollary that there is no preferred standard of truth: Except for the
occasional cooperative freshman, one cannot find anybody who says that two
incompatible opinions on an important topic are equally good. The
philosophers who get called relativists are those who say that the grounds
for choosing between such opinions are less algorithmic than had been
thought.
This book notes that by accepting relativism we are accepting that different
standards of justification of an explanation exist within the social sciences.
The standard of this book understanding and explaining policy dynamics
requires making sense of unique temporal sequences. The chapter has set out
the key foundational assumptions of policy narratives and how they allow
explanation of policy development:
l
74
Theory
These key principles act as the foundation of policy narratives; they inform
what should be included, which are the key stages, how those stages should be
analysed, and they push the analyst toward constructing a coherent narrative,
which makes sense of a unique temporal sequence of policy development. By
virtue of acting as the foundation of policy narratives, these principles also act
as a guide for the evaluation of narratives as explanations of policy dynamics.
PART II
Evidence
78
Evidence
choice of a single institution at one point in time that then persists or is stable.
This has an immediate obvious appeal in terms of explaining the
development of the EU budget system where the Balanced Budget Rule (BBR)
in the 1957 Treaty of Rome, and the 1970 Luxembourg Treaty distinction
between Compulsory Expenditure (CE) and Non-Compulsory Expenditure
(NCE), have persisted unchanged, consistent with a path-dependent process.
Further, one of the standard micro-mechanisms in an increasing returns
process is the existence of significant switching costs. Replacing the existing
constitutionally entrenched budgetary framework would be costly politically,
as budget reform tends to be a zero-sum game, or where switching costs are
significant, a negative-sum game. Since Treaty changes require unanimous
agreement by the member states, potential losers possess a veto.
If we adopt the perspective of the budget system as a single whole, this
expedites the use of path dependency as a concept that insists on an overall
trajectory for an institution and institutional configuration, the direction of
which is reinforced after early moves in the sequence. This is fine; however the
issue raised in Chapter 3 is that within a path-dependent system some elements
may be fixed or locked-in, while others are capable of being reformed. Also
within a path-dependent system, space may exist for the introduction of new
institutions. This is crucial to my analysis here: the initial budgetary
framework set in train path-dependent process in which institutional change
has been observed, and as will be shown, new budgetary institutions have been
made or remade for various reasons with a variety of effects but all have been
premised on the continuation of the initial budgetary framework; that is, all
change has occurred within that framework.
The danger of adopting an institutional configuration the budget system
as the unit of analysis is the creation of too sharp a distinction between
stability and change, as seen in on-path versus off-path change. This is a
function of the granularity of perspective and is a general charge against
historical institutionalism and path dependency. This unit of analysis leads
some to see 1988 as a path-breaking juncture in the EU budget system, with
the introduction of a new institutional setting: The comparison between the
final breakdown of the 1970 institutional setting and the continuous stability
of the 1988 institutional setting revealed that the specific combination of
reproduction mechanisms present in the 1988 setting was better equipped to
sustain stability (Lindner 2003, p. 932).
In the narrative presented here, institutions exist in combinations: they are
interdependent, with necessary and contingent relationships. Thelen (2003)
describes examples where institutional lock-in is combined with elements of
institutional innovation that can push the overall trajectory of policy and
politics in a different direction. This encourages a shift in the ground from a
sharp distinction between institutional persistence and institutional change
79
80
Evidence
reform; it rather led to the introduction of another budget institution. Thus the
process was not classic trial and error, in the sense that budget institutions that
had not worked were not dismantled; they were instead added to. The process
of accumulation of additional and complementary institutions to avoid the
tendency to crisis is the dominant dynamic in the development of the EU
budget system.
81
82
Evidence
83
the budget system (where failure was judged by the emergence of a new
crisis), new reforms were tried. The accumulation of these additional
budgetary institutions is the salient pattern of the institutional dynamics of the
EU budget system.
In understanding the evolution of the EU budgetary institutional matrix, it
is important to stress that the BBR, in combination with the OR system,
ensured that negotiations between member states in the Council on changes to
budget rules, or the introduction of new rules, were a zero-sum game. In
response to budget crises, member states had two main preferences for
institutional change: first, to optimize their net budgetary position and second,
to ensure their budget position was relatively stable across time. Given the
zero-sum nature of the negotiations, institutional change that satisfied the first
type of preference for all member states was infeasible. However, an
institution that achieved the second type of preferences was possible. The data
presented in Ackrill and Kay (2006) show a secular decrease in the volatility
of annual net budgetary positions for almost all member states. This was the
key microfoundation in the agreement of options for budget reform.
84
Evidence
85
Germany was the largest net contributor, its contribution to the UK rebate was
reduced by one-third (with the additional cost shared among the other member
states). Third, in response to concerns over the unrestrained growth in
spending, general guidelines were produced for Budgetary Discipline,
transformed into several rules in December 1984. The most important of
which were that the Council of Finance Ministers should set a reference
framework for total expenditure, with other Councils asked to ensure that their
decisions respected this, and that the growth rate of CAP spending should not
exceed the growth rate of own resources.
This was the first public recognition of the design flaws in the initial
framework; that the BBR was an incomplete institution without the
complementary institutions to control expenditure. There was however no
incentive for other Councils, most notably CoAM, to respect the spending
guideline. As a domain constraint, Budgetary Discipline remained flawed:
there were no institutions proposed or agreed that gave effect to the agreed
spending limits. In terms of this development as an example of evolutionary
policy learning, this was the first of a series of reforms that failed to
institutionalize mechanisms to limit expenditure by Councils and respect the
fiscal constitution of the EU.
86
Evidence
87
88
Evidence
SUMMARY
Institutional reform can have extremely high political costs, in terms of the
bargaining of agreement on a new institution, the switching costs from old to
new, and the transaction costs of adapting to and learning a new institution.
These costs are also subject to an increasing returns process; the more
89
91
92
Evidence
93
94
Evidence
unchanged since 1958. Moreover, most reforms prior to 1992 left the
underlying principles of price support intact. The one notable change to price
support (agreed in 1988) was an automatic price cut if production exceeded a
Maximum Guaranteed Quantity. Some of the reforms shown in Table 7.1
merely limited the extent of price rises (notably Guarantee Thresholds), whilst
even when support prices were cut (for example, through the cereals
Co-Responsibility Levy (CRL) and Stabilizers) the reduction was modest.
Given that the margin of EU prices over world prices was often in excess of
50 per cent, the fundamental basis of policy and the resulting production
incentives remained unchallenged.
Table 7.1 CAP reforms before 1992 a summary of key features
Date
Reform
Description
Pressure Binding?1
1977
Dairy CoResponsibility
Levy (CRL)
Guarantee
thresholds
(multicommodity)
Budget
No
Budget
No
Budget
Yes
Budget
No
Budget
No
1982
1984
1986
Dairy
production
quotas
Cereals CRL
1988
Stabilizers
Notes:
1 A constraint is defined as binding if the need for reform is immediate.
Of the reforms shown in Table 7.1, dairy quotas stand out as the only one to
limit spending by building some kind of constraint (production) into CAP
policy instruments. In 1988 the original stabilizer proposal had been for a
spending-based trigger, but this direct control on spending proved
unacceptable politically. Thus, other than for the dairy regime, CAP support
has remained open-ended. As set out in Table 7.1, dairy quotas were the only
95
reform enacted under binding pressure, created by the BBR. Spending had
exceeded the revenue ceiling in 1983 but over ECU800 million of CAP
spending and the ensuing crisis were merely delayed by transferring them
to the 1984 budget.
Path dependency can be used to structure a narrative of these changes in
terms of the price support system limiting the options for reform. Moreover,
the changes that have been introduced have reinforced the development of the
CAP along its existing, particular path. Notably, the underlying operating
principle of quotas production in excess of a certain quantity triggering a
financial penalty was the same as Guarantee Thresholds, the difference being
the size of the penalty. This also implied continuity in administration, with
some tasks also devolved to the member states, or even to individual dairies.
Moreover, quotas were chosen over two alternatives, a rise in the CRL and a
cut in the intervention price, on the basis that these would have undermined
the principle of price support.
Support prices remained high with quotas. Indeed, domestic politics,
especially in Germany, meant that retaining high prices was a prerequisite for
securing the 1984 reform agreement. By containing spending quotas also
targeted the one binding constraint, thus winning support from those countries
concerned by rising CAP spending. Quotas thus reconciled member states
whose positions were otherwise mutually exclusive. Although spending
growth was contained by quotas, spending levels were only reduced
subsequently as quota levels were reduced. In the meantime the spending limit
was again breached in 1985, the deficit covered by additional payments from
the member states. From 1986, a previously agreed rise in the spending limit
helped restore budgetary balance.
A feature common to both the 1984 and 1988 reforms was the nonexclusivity of the policy network driving change. Until then, the perception
was that the Commission and CoAM worked in a closed system with farmers
and agri-business interests to shape policy. Further, as noted in Chapter 6, the
financial system of the EU worked in a manner that accommodated the
financial consequences of CoAM decisions. As the BBR was threatened then
breached, the influence of the Budget Commissioner and national Finance
Ministers became prominent in the CAP policy system. Moyer and Josling
(1990, p. 70) described an inner circle of Commissioners, appointed in 1985,
who drove the 1988 reforms Commission President Jacques Delors,
Agriculture Commissioner Frans Andriessen and Budget Commissioner
Henning Christophersen (and their cabinets).
Given this composition and the role the budget played in forcing CAP
reform, it was no coincidence that 1984 and 1988 also saw changes to the
budget and budget process. In 1984 it was agreed to limit annual CAP
spending growth to 2 per cent. This formal institution could have represented
96
Evidence
97
98
Evidence
wider arable regime in 1992, was accepted. The EU was, in effect, able to
use the oilseeds reform as a test bed and precedent for the arable sector
reform.
The 1992 set-aside provision also developed from pre-existing CAP
instruments. A voluntary set-aside scheme was first introduced in 1988. It was
then extended by the 199192 price package, when (large) cereals farmers
could gain exemption from a 5 per cent CRL if they set aside 15 per cent of
their land. Both the 1991 and 1992 changes kept set-aside participation
voluntary but they progressively raised the cost of non-participation.
99
100
Evidence
101
politics and history of Germany make for a complex attitude towards CAP
reform (Wilson and Wilson 2001).
During the negotiations of the 2003 reform, countries opposing or
supporting reform generally matched the foregoing classification closely.
Moreover, when presenting the proposals to the European Parliament in 2002,
Commissioner Fischler stated that by these measures we intend to give
consumers and taxpayers a recognisable service in return for the tax they pay
(speech 02/330) thereby seeking to justify the current level of transfers rather
than seeking lower spending. Indeed the proposals were drawn up with a view
to achieving the objective of stabilising agricultural expenditure in real terms
(European Commission 2002, p. 29, emphasis added).
As regards sums received by member states, the SFP is based on actual
direct payment receipts over the period 200002, a move that will sustain the
existing inter-country distribution of expenditures. Moreover one of the
concerns expressed by member states over modulation, including pro-reform
countries such as the UK, was that the recycling of money could also result
in a redistribution between member states. Whilst the final agreement did not
rule out redistribution, it did limit it. The first percentage point of the 5 per cent
of direct payments to be modulated must remain in the source country and
overall a minimum of 80 per cent of total recycled funds must remain at
home.
102
Evidence
103
spending, a move made easier by the switch from price support to direct
payments. Some observers viewed EU enlargement as a way of forcing radical
CAP reform because of the budgetary pressure that would result. The latest
negotiations showed how wrong that view was. Moreover, the analysis here
helps explain why the existing member states presented the accession package
they did. Maintaining the existing distribution of CAP transfers for the EU15
was more important than maintaining the commonality of the CAP across all
member states.
SUMMARY
I have presented a narrative in terms of the price support mechanisms of the
CAP, and the financial and international trade consequences structured by the
concept of path dependency. This is a single, coherent story that makes sense
of the evidence of the budgetary consequences of the CAP and periods of CAP
reform. However, the narrative misses other aspects of the development of the
CAP, for example the increasing pressure at national and EU levels to take
account of the deleterious environmental consequences of the CAP in policy
considerations; or NGO campaigns around the disastrous consequences of the
CAP for many developing countries reliant on primary commodity exports.
The question not addressed is whether these political discourses around the
policy system are having the effect of gradually eroding the CAP policy
paradigm. These gaps are in the nature of any structured narrative of the
dynamics of a complex, multi-dimensional and multi-national policy such as
the CAP; the constituents in the CAP system are in constant flux, its
consequences are multi-faceted and spread out over a significant temporal
scale. As established in preceding chapters, it is the nature of narratives of
dynamics to be backward looking: changes in the CAP policy system are best
judged retrospectively; and obviously the emergence of confirming evidence
of the effect of environmental or development actors on the CAP policy
system will affect the extent to which the structured narrative I have presented
here is held as a valid or true explanation of the contemporary policy dynamics
of the CAP.
105
terms of the rules of the game, privileging certain interests and supporting a
dominant view of the world. Although the enactment of the 1991 NHS
reforms, and GP fundholding in particular, is a useful temporal identifier for
the end of the policy community in health care, the breakdown of a policy
community was not a single event but rather a process of transition from a
strongly institutionalized policy system to one that is less structured, more
contested and prone to instability. Importantly, after the breakdown of a policy
community there is no automatic institutionalization of a new policy
community or the establishment of a fresh policy paradigm.
In the structured narrative presented in the chapter, the policy community
and its ideational base disintegrated in a conflux of internal and external
processes: budgetary pressures in the NHS; a perceived inability to satisfy
citizens rising demands for health care; an intense politicization of health in
electoral terms in 1987; waning of trust among members; along with reduced
expectations that the institutions of the policy community would be respected.
The dynamics of the breakdown of the health policy paradigm in the UK was
not a Kuhnian scientific revolution in the sense of an existing paradigm no
longer explaining the facts, and where the weight of disconfirming evidence
for a particular world view reaches a critical level where the paradigm
collapses. Indeed Hall (1993, p. 291), who introduced the term policy
paradigm, admitted that the notion of a narrow, cognitive frame that sets strict
constraints on policy thinking is not universal: only in some cases is it
appropriate to speak of a fully elaborated policy paradigm In others, the
web of ideas will be looser and subject to more frequent variation.
Nevertheless, even in this latter sense, the concept of a policy paradigm is
useful in structuring the narrative; it is the fragmentation of the policy
paradigm after 1987 that triggered some of the key dynamics of policy
development in the 1990s; a process of competing problems, ideas and
policies.
In Chapter 4, it was suggested that the evolutionary metaphor is a useful
way of organizing thinking about policy learning by distinguishing adaptation
(learning that affects calculations about how to realize interests within the
institutional structure of the policy community) from more complex learning
where interests, identities or institutions are learned or constructed in the
interaction of agents in the policy system. In the second sense of learning the
problem situation is constructed in the interactions between agents, the
negotiations of policy problems, policy solutions and criteria of success. In
alternative terms, learning is the process of agreeing standards for the
intentional selection mechanisms that operate to weed out policy failure; it is
through this construction that policy paradigms, however narrow or loose,
emerge and are institutionalized. This concept of policy learning is used to
structure the description of the process of health care policymaking after 1989
106
Evidence
107
108
Evidence
109
than (D, D). However, there are large transaction costs associated with
negotiating, implementing and monitoring the agreement for both actors to
cooperate. The emergence of trust between actors helps ameliorate these
transaction costs as informal rules and tacit understanding emerge to support
a (C, C) equilibrium. Hindmoor (1998) argues that the negotiations between
the BMA and the government between 1946 and 1948 were a repeated PD
game, in which trust emerged through the development of informal rules and
tacit understandings to support a stable (C, C) equilibrium. A stable (C, C)
equilibrium can be interpreted, in terms of the health care policy community,
as each actor trusting the other actor to observe its emergent institutions over
time.
There were two institutions that underpinned the operation of the health
care policy community between 1948 and the mid-1980s. The first was that
each actor should trust the other on both the process and substance of
policymaking. Hindmoor (1998) and Wistow (1992) talk of trust becoming
embedded in the health care policy community. This trust supported a
consensus on how business was to be conducted, as Jordan and Richardson
(1987, p. 101) describe it the process by which and the atmosphere within
which policymaking is decided. In particular, this meant the exclusion of
other potential interests in health care policy, for example public opinion,
Parliament, the rest of Whitehall and hospital managers. Ham (1992), Webster
(1988), and Klein (1995) describe how this exclusion became heavily
institutionalized after 1948. The BMA had privileged access and a central role
at every stage of the policymaking process.
The second rule of the game was an implicit contract between the
government and the medical profession. The contract was that the former
respected clinical autonomy in how to use resources but the latter accepted that
the decision on the overall level of resources, the budgetary constraint, was a
matter for the government. The observance of these two rules marked the
policy community period in UK health care policy.
Within this well-established policy community, there was policy learning
and limited policy change. For example, Royal Commissions were the main
conduits for the introduction of ideas and evidence into health care
policymaking during the policy community period. They received
submissions, interviewed experts and interrogated advice. Their reports, along
with the input of the comprehensive central expert advisory machinery which
was built up between 1948 and 1979 (Webster 1998a, p. 29) constituted the
evidence that informed most of the structural changes to the NHS prior to 1991
(Webster 1988, 1996, 1998a).
Policy changes before the late 1980s reflected the policy community that
introduced them. They were never radical, they concentrated on the structure
of the NHS as a way of influencing the behaviour of staff and they were
110
Evidence
111
112
Evidence
between 1989 and 1997, the immediate post-policy community period, was
the absence of a shared policy paradigm through which incremental, evidencebased policy learning could take place. The two established mechanisms for
introducing evidence into policymaking did not operate. There was no Royal
Commission set up, and the central advisory machinery had largely been
abolished by the Thatcher administration. Importantly, there was no formal
appraisal or evaluation of the effect of GP fundholding on health care or
health. This contradicts the view that the reforms of 1991 represented a victory
for the new public sector management in the NHS. Instead, the reforms
marked the end of the health care policy community and the start of health care
policy being driven by political conflict and the struggle to institutionalize
guiding assumptions and values about health care policy.
The evidence on which policy development was based under the policy
community was undoubtedly biased towards the medical professions view of
the health care system, as this was the policy paradigm. As Webster (1988,
1996 and 1998a) discusses, Royal Commissions collected evidence from the
medical profession about how the NHS was working and how any reform
proposals might work. The nature of that evidence reflected the
professionalized network that controlled its collation and reporting.
Without a policy community, there was no consensus on the introduction of
GP fundholding, and therefore there were no common values against which to
evaluate the scheme. Both Nigel Lawson (1992) and Mrs Thatcher (1993)
expressed the considerable worries that the Conservative government had
about the BMA exploiting any policy appraisal or evaluation of the GP
fundholding scheme: any formal policy evaluation would not have been
evidence to inform rational policy development but instead would have been
appropriated for political advantage. As public opinion had become a factor in
health care policy there was no time for the government or BMA to wait and
see the effects of any pilot scheme or policy assessment. Instead, each interest
articulated a public position immediately; policy analysis and public positions
were based on folk theorems or common beliefs about the traits,
characteristics or dispositions of a policy without any reliable and verified
source of evidence.
In the absence of trust, debates about the consequences of the GP
fundholding scheme were highly political. For example, in July 1995 the
Labour Party restated its criticisms of the scheme (Labour Party 1995): their
position was that fundholding had increased NHS management costs,
introduced financial pressures into the doctorpatient relationship and had
created a two-tier health service. These were claims based on folk theorems,
as there was no obvious evidence for any of them. Some politicians may have
calculated that vilifying the scheme was the best political response, as any
initiative that attempted to introduce financial management into the NHS was
113
114
Evidence
115
found that, in the short term, many early-wave fundholders had managed to
secure economies in their prescribing by switching to cheaper, generic drugs.
However, in the longer term, such savings may not have been sustainable. In
one of the last reviews of the literature before abolition, Smith and Wilton
(1998, p. 1253) concluded that evidence concerning the success or otherwise
of general practice fundholding over the last six years is incomplete and
mixed and, unless further research was undertaken, the jury will have to
remain out on whether fundholding has secured improved efficiency in the
delivery of health care.
Both the Conservative government and the Labour Party (and subsequently
Labour government) had clear public positions on the effect of GP
fundholding. These positions did not have a basis in evidence; one of the
dynamics set off by the collapse of a policy paradigm is a contestation of the
basic values and assumptions that will be used to consider policy development.
Without this information, there is no basis on which evidence-based
policymaking can take place; instead the benefits and costs of a particular
policy is the subject of strong political contestation in which policy analysis is
often a case of the assertion of various folk theorems.
116
Evidence
117
SUMMARY
This chapter has set out the history of the GP fundholding scheme as an
example of policy dynamics after policy communities collapse and where the
government has an ambition for substantial policy change. The absence of
trust between the major interests means that policy tends to be formulated
without valid or reliable evidence on the effects and cost-effectiveness of
existing initiatives and any proposed new initiatives. In this sense, the 1991
NHS reforms were not a victory for the new public sector management at the
expense of clinical autonomy, but rather marked the beginning of a period of
turbulence in health care policy between 1991 and 1997 (and subsequently).
The GP fundholding scheme is a case study in how health care policy in the
1990s was driven by folk theorems and political competition; health care
problems and policy solutions were learned or constructed in the interaction of
agents in the policy system. In this sense of policy learning, the problem
situation is constructed in the interactions between agents; policy problems,
policy solutions and the criteria of success are bargained and different
attempts are made to constitute institutions within the policy system.
The structured narrative in the chapter is inconclusive on the question of
whether the period 199197 was an aberration in the style of health care
policymaking. The existence of a publicly funded and publicly owned NHS
had seemed to afford doctors a privileged position relative to other groups.
Many of the institutionalized forms of access for the medical profession of the
policy community era have remained. However, Ham (1999, p. 1092) notes the
Labour governments apparent willingness to challenge the power of its
traditional support base in the trade unions and entrenched interests of the
health professionals, including doctors. The 15 years since the break up of the
post-war health care policy paradigm have been marked by a fluid dynamics
of shifting balances and patterns of influence and values within the NHS,
without a particular policy paradigm becoming institutionalized.
9. UK pharmaceutical policy
The tendency of doctors to overprescribe medicines because they do not bear
the cost of the decision to prescribe, and the monopoly that pharmaceutical
companies enjoy in the production of certain medicines under patent, are both
long-standing justifications for pharmaceutical public policy to regulate the
price of medicines (Bloom and Van Reenen, 1998). All OECD countries have
some form of regulation of the pharmaceutical industry and mechanisms to
control public expenditure on medicines. These policies have been under
budgetary pressure in most countries since the 1980s due to the combination
of an ageing population and technological development. NHS expenditure on
prescription medicines increased by almost 10 per cent per annum during the
1990s (OHE, 2002). This fiscal pressure has produced a series of policy
dynamics that exemplify how policy processes are as much about choosing
between different reasons for action or different values, as they are about how
to achieve particular values in isolation. This insight complements the point
made in the theoretical section of the book: a dynamic perspective raises
serious doubts about the instrumental, parametric version of rationality that
exists in rational choice theory by challenging the notion of a straightforward
policy choice.
Public policy towards pharmaceuticals can be divided into those aimed at
influencing the demand for medicines, chiefly to increase the sensitivity of
GPs to the cost of medicines, and those aimed at regulating the supply side,
the price paid for medicines by public authorities. In the UK, since the mid
1980s there have been a series of initiatives to influence GP-prescribing
behaviour. On the supply side, the Pharmaceutical Price Regulation Scheme
(PPRS) is an agreement between the pharmaceutical industry and the
government that has been renegotiated roughly every six years since 1957; the
latest agreement came into force on 1 January 2005. The PPRS is unique in
the EU pharmaceutical policy area in regulating drug company profits rather
than prices directly, although relatively small one-off reductions in the average
price of the portfolio of drugs supplied by a company to the NHS were agreed
in 1993, 1999 and 2005.
The PPRS has a dual identity; it is both an industrial policy to support
pharmaceutical companies and the mechanism by which the NHS procures
drugs. There is an ineluctable conflict between those two identities. They
represent different values or rationalities for public policy that are directly
118
UK pharmaceutical policy
119
120
Evidence
UK pharmaceutical policy
121
122
Evidence
The PPRS is, de facto, an industrial policy; it affects the profitability and
structure of the UK pharmaceutical industry. Further, the industrial policy
element is explicit in the objectives of the scheme. As most recently stated
(DoH, 2004), they are to: (i) secure the provision of reasonably priced, safe
and effective medicines to the NHS; (ii) promote a strong and profitable
pharmaceutical sector capable of such sustained R&D expenditure as should
lead to the future availability of new and improved medicines; and (iii)
encourage the efficient and competitive supply of medicines to pharmaceutical
markets in this and other countries.
As previously indicated, the PPRS as a mode of regulation is akin to a
gentlemans agreement. The metaphor is a useful description because it
captures the high-trust, personal relationships that have existed between the
government and the pharmaceutical industry away from public scrutiny.
Common to all regulatory systems is an information problem; the regulator
cannot directly observe the cost structure of the regulated company. The PPRS
has dealt with this problem by allowing the industry a large degree of selfregulation on a voluntary basis. The branch of the DoH that operates the PPRS
consists of only 20 people (DoH, 2004). The majority of these will be in
clerical grades and the Branch Head is a Grade 7, a middle-management grade
that is not part of the senior civil service structure. Therefore, it is a reasonable
assumption that this branch cannot engage in detailed scrutiny of the
information provided by companies in the PPRS. Rather, the level of resources
that the DoH commits to the scheme is only sufficient to ensure the schemes
routine administrative functioning. The DoH must take on trust the validity of
the large majority of the information provided by the pharmaceutical
companies in their AFRs. In these terms, the PPRS is a relationship-based
rather than a rule-based regulation and the metaphor of a gentlemans
agreement expresses the nature of that relationship.
In contrast, UK utility regulators are independent agencies with a large staff
and substantial resources. For example, OFTEL has a staff of over 160
(OFTEL, 2004). They play a quasi-judicial role in protecting customers and
exist in an adversarial relationship with the regulated company. The approach
to the information problem is to pursue detailed analysis and scrutiny of the
information revealed by the company, their accounts and forecasts, in order to
formulate an optimal price that the company can charge.
The gentlemans agreement mode of regulation seems to have been
successful in preventing a hold-up problem in the relationship between the
government and the pharmaceutical industry. A hold-up problem occurs in a
contract between two parties where one of the parties has to make some kind
of investment that is irreversible. In this case, it is R&D expenditures by
pharmaceutical companies that are irreversible. The party that makes such an
investment becomes vulnerable to the demands of the other party to
UK pharmaceutical policy
123
renegotiate the contract; in this case, the government imposing drug prices that
are close to marginal cost and substantially lower than had been anticipated at
the time of the R&D investment. Given the frequent cash crises in the history
of the NHS (Webster 1988, 1996) and the continually rising public
expenditure on drugs, there always exists an incentive for governments to
impose a low price regime on the pharmaceutical industry. In game theory
terms, the governments promise to keep prices at a level to reward investment
in R&D is not time consistent (Dixit 1996).
This potential threat of government expropriating the returns for investment
in future time periods should tend to lead to severe under-investment by
pharmaceutical companies. However, there is considerable evidence of the
long-run success of the UK pharmaceutical industry (Maynard and Bloor
1997; Martin 1995; Earl-Slater 1997) and in particular, its high rates of R&D
expenditure (Bloom and Van Reenen 1998). The gentlemans agreement
established a level of trust between the industry and the government that has
given credibility to commitments not to cut future prices. The PPRS, in terms
of the value of supporting the development of high value-added industry in the
UK economy, has been successful. However, as previously noted this conflicts
with the value of maximizing the health benefits of a limited public budget for
medicines.
124
Evidence
in 1986 (Luce, 1987) marks the beginning of the increase in the number of
pharmaceutical policy instruments. Any number of pharmaceutical companies
can supply a generic drug because the patent guaranteeing a monopoly in the
production of that drug has expired. Generics trade under the British Approved
Name of a drug rather than a brand name. They were removed from the PPRS
in order to encourage a market with price competition. As generic medicines
are usually considerably cheaper than their branded equivalent, it was hoped
that GPs would prescribe, where available, a generic drug rather than its
branded alternative, thereby securing economies in the NHS pharmaceuticals
budget. The various generic prescribing initiatives that followed (see for
example Audit Commission 1994) have successfully raised the rate of
prescribing generically in England and Wales to close to 70 per cent of items
(from 40 per cent prior to 1986), representing around a fifth of the total value
of prescription medicines.
The development of a generics market came alongside the introduction of
the GP fundholding scheme in 1991 (see Chapter 8). This scheme allowed
participating practices to keep any savings they could make on their purchases
of drugs. These initiatives provided a financial incentive to GPs to limit the
effect of their prescribing on pharmaceutical expenditure. However, any
control of NHS expenditure on pharmaceuticals is a control on pharmaceutical
companies revenues. The combination of competition through generic
substitution and a system of price regulation in the market for non-branded
drugs has had the effect of reducing the life cycle of branded products as the
revenues expected by a branded manufacturer post-patent expiry have been
reduced. This means that branded manufacturers have been forced to make
their return on R&D investment over the period of the patent instead of over a
longer period.
The freedom given by the PPRS to companies in the pricing of new drugs
means that pharmaceutical policies to control the growth of drug costs will
tend to be undone by the ability of the drug companies to increase their
revenues (NHS drug expenditure) through the launch price of new drugs. The
average price of branded medicines prescribed increased by about 47 per cent
in real terms over the period 198898, whilst the average price of generic
medicines has remained about the same in real terms over the same period
(Kay 2002). However, under the PPRS the price of existing medicines can
only be increased by application to the DoH. There are very strict criteria for
allowing a price increase (DoH 2004) and the industry view is that such
applications tend to be unsuccessful (Lawton 1999). It therefore seems
reasonable to infer that the major determinant of the steep rise observed in the
price of branded medicines is the increased average price of new medicines
launched.
The data tend to show that these developments in GP prescribing policy
UK pharmaceutical policy
125
over the last 20 or so years have been successful in controlling the volume of
items prescribed. The growth in volume of items has been roughly half that of
the average price of an item. However, the policies to influence GP prescribing
had a greater objective than simply influencing the prescribe/not prescribe
decision; they were supposed to make GPs more price-sensitive when taking
the decision to prescribe a particular drug. The demand-side policies since the
1980s were designed, all other things being equal, to reduce the average price
of a prescription item. However, since the mid-1980s all other things have not
been equal. As noted, supply-side regulations have operated in a contradictory
way to demand-side policies by allowing industry profits on sales to the NHS
to remain at historic levels because the initial price of new medicines is not
controlled under the PPRS. The introduction of NICE discussed in the
following section is the latest attempt to close this persistent gap in the
regulatory framework of the PPRS and another stage of value cycling within
pharmaceutical policy.
126
Evidence
NHS are administered and enforced by the industry itself. There was no
increase in the resources available for regulatory scrutiny to the levels usually
associated with utility regulation. There are still only 20 officials operating the
scheme in the DoH and although the details of the operation of the scheme
have been reported to Parliament annually since 1996, the scheme remains
opaque from the outside; in particular, there is no evidence of a
confrontational, hard law regulatory style with frequent recourse to the
statutory courts to enforce the rules of the scheme.
Independently of, but contemporaneous with, the 1999 PPRS negotiations,
NICE was established with the objective of producing clinical guidelines on
the clinical and cost effectiveness of medical interventions. It replaced a
system in which individual health authorities took their own decisions on the
funding for new drugs and technologies. This system had resulted in variations
in the patterns of commissioning across the country, with varying access to
specific treatments and allegations of rationing by postcode. These decisions
had generally been taken in response to resource pressures and financial
reductions rather than research into the cost-effectiveness of medical
interventions.
As stated, the PPRS does not directly regulate prices but instead controls
profit, with pricing freedom given to companies when launching branded
medicines. NICE, however, is a form of price regulation; it judges the cost
effectiveness of a medicine. However, the cost-effectiveness methodology that
NICE use to make comparative judgements across diseases and for clinical and
technology appraisal benchmarks are opaque and open to dispute (Williams
2004); implicit is the recommendation of a price that provides a benefit to cost
ratio that is acceptable for public expenditure on health care. There is therefore
an inconsistency between Labour opting to renegotiate the PPRS in 1999 and
also introducing NICE. The price of branded drugs is a policy variable
performing two potentially contradictory regulatory functions: rewarding
innovation and providing cost-effective treatment. Prior to NICE, the price of
drugs in the PPRS was the outcome of political negotiations for a reasonable
level for the NHS and the industry. The requirement for NICE to reach an
opinion on the cost-effectiveness of a drug may lead to a more formal and
confrontational regulatory relationship between the government and the
industry as public recommendations, with adverse profit consequences. The
relationship will be further complicated by the trend in the demand for
medicines: this is no longer simply a function of physicians prescribing habits
when acting as agents of patients, but rather is patient-led, where responsibility
for health care is increasingly individualized and where certain groups and
interests are organizing successfully for public subsidy of their medicines.
The PPRS agreement covering 200510 was the subject of far less public
debate than in 1999. There have been a few very minor changes, but the
UK pharmaceutical policy
127
scheme remains essentially the same as that under the 1999 agreement: the
objectives remain, its statutory basis under the 1999 Act is untouched, and
there was an agreed average price reduction of 7 per cent this time (compared
to 4.5 per cent in 1999). In order to limit room for manoeuvre in complying
with price cut commitments and increase transparency and competition in the
generics market, branded generics have been excluded from the PPRS. These
are out-of-patent products to which suppliers, who did not ever hold the patent,
have applied a brand name. Any encouragement of the generics as set against
the branded industry is an assertion of the objective of securing value for
money in public spending on medicines.
128
Evidence
be threatened and the ability of the NHS to predict and control overall drug
expenditure would be diminished (ultimately adversely affecting patients
through unplanned and random rationing).
The combination of complex policy spillovers suggests the need for policy
or institution to regulate the governmentpharmaceutical industry relationship
and manage the value conflict that has produced the process of cycling,
described in the previous sections, with the adverse consequences for policy
coherence. There is no institution or policy independent of the DoH, which
takes an overall view of the regulation of the pharmaceutical industry, to in
particular take account of the spillovers between different policy instruments.
In particular, an OFDRUG, equivalent of OFTEL or OFWAT, could help to
ensure that there is a consistent and stable approach to regulation. One of the
rationales for an independent regulatory agency for the privatized utilities was
the necessity for a stable regulatory environment to allow for long-term
resource planning away from short-term political pressures. In the case of
pharmaceutical regulation, both the NHS and the pharmaceutical industry
wish to plan resource allocation over a long time horizon.
There are two practical roles an OFDRUG could adopt to ensure this
stability. The first would be to ensure that NHS expenditure on
pharmaceuticals is cost-effective. The separate and political question of the
affordability of a medicine or the overall size of the pharmaceutical budget
would remain for the DoH. A second and related role would be for an
OFDRUG to control both the recommendation of new medicines for use and
the funding for their implementation; currently Health Authorities may ignore
NICE guidance on the financial grounds that the introduction of a new
medicine would compromise its locally agreed priorities.
The low level of administrative resources dedicated to the PPRS by the DoH
was sustainable in the period of relationship-based regulation with high trust
between the regulators and the regulated. However, the robust policing of the
PPRS, the regulation of the generics market and administration of NICE rules,
as well as the required analysis of the extent of spillovers, would require
substantial expertise and resources. The question for the future development of
UK pharmaceutical policy is: whether any such single body can be designed
to manage the unavoidable value conflict; whether the complexities and
inconsistencies precipitate a crisis and radical reform; and whether the policy
system can self-organize under the selection pressures of fiscal constraints and
global industry demands.
SUMMARY
For many years drug price regulation posed few public management problems.
UK pharmaceutical policy
129
References
Ackrill, Robert W. (2000), The Common Agricultural Policy, Sheffield:
Sheffield Academic Press, for the University Association for Contemporary
European Studies.
Ackrill, Robert W. and A. Kay (2005), Measuring path dependency in the
CAP, unpublished manuscript.
Ackrill, Robert W., R.C. Hine, A.J. Rayner and M. Suardi (1997), Member
states and the preferential trade and budget effects of the 1992 CAP reform:
a note, Journal of Agricultural Economics, 48, 93100.
Anonymous (1984), Two tier service feared, British Medical Journal, 289,
14689.
Arrow, K.J. (2000), Increasing returns: historiographic issues and path
dependence, The European Journal of the History of Economic Thought, 7
(1), 17180.
Arthur, W. Brian (1988), Self-reinforcing mechanisms in economics, in P.W.
Anderson, K.J. Arrow and D. Pines (eds), The Economy as an Evolving
Complex System, Reading, MA: Addison Wesley, pp. 122.
Arthur, W. Brian (1994), Increasing Returns and Path Dependence in the
Economy, Ann Arbor, MI: University of Michigan Press.
Audit Commission (1994), A Prescription for Improvement: Towards More
Rational Prescribing in General Practice, London: HMSO.
Audit Commission (1995), Briefing on GP Fundholding, London: HMSO.
Audit Commission (1996a), Fundholding Facts: A Digest of Information
About Practices Within the Scheme During the First Five Years, London:
HMSO.
Audit Commission (1996b), What the Doctor Ordered: A Study of GP
Fundholders in England and Wales, London: HMSO.
Auyang, Sunny Y. (1998), Foundations of Complex-System Theories,
Cambridge: Cambridge University Press.
Baines, Darrin, Keith Tolley and David Whynes (1997), Prescribing, Budgets
and Fundholding in General Practice, London: Office of Health
Economics.
Bates, Robert, Avner Grief, Margaret Levi, Jean-Laurent Rosenthal and Barry
Weingast (1998), Analytical Narratives, Princeton, NJ: Princeton
University Press.
Baumgartner, Frank and Bryan Jones (1993), Agendas and Instability in
131
132
References
133
134
Prentice Hall.
Earl-Slater, A. (1997), Regulating the price of the UKs drugs: second
thoughts after the governments first report, British Medical Journal, 314,
3658.
Easton, David (1965), A Framework for Political Analysis, New York: Prentice
Hall.
Easton, David (1966), A Systems Approach to Political Life, Indiana: Purdue
University Press.
Elster, Jon (1976), A note on hysteresis in the social sciences, Synthese, 33,
37191.
Elster, Jon (1980), Cohen on Marxs theory of history, Political Studies,
XXVIII (1), 12128.
Elster, Jon (1983), Sour Grapes: Studies in the Subversion of Rationality,
Cambridge: Cambridge University Press.
Elster, Jon (1998), A plea for mechanisms, in Peter Hedstrom and Richard
Swedberg (eds), Social Mechanisms: An Analytical Approach to Social
Theory, Cambridge: Cambridge University Press, Chapter 3.
Elster, Jon (2000), Rational choice history: a case of excessive ambition,
American Political Science Review, 94 (3), 68594.
Enthoven, Alan (1985), Reflections on the Management of the NHS, London:
Nuffield Provincial Hospital Trust.
Esping-Anderson, Gosta (1990), The Three Worlds of Welfare Capitalism,
Princeton, NJ: Princeton University Press.
European Commission (1958), First General Report on the Activities of the
Community, Brussels: Publications Department of the European
Communities.
European Commission (2002), Mid-term review of the Common Agricultural
Policy, Communication from the Commission to the Council and the
European Parliament, COM(2002)394 final, Brussels, 10 July.
Fischer, Frank (2003), Reframing Public Policy, Oxford: Oxford University
Press.
Foster, John (1997), The analytical foundations of evolutionary economics:
from biological analogy to economic self-organisation, Structural Change
and Economic Dynamics, 8, 42751.
Georgescu-Roegen, Nicholas (1967), Analytical Economics, Cambridge, MA:
Harvard University Press.
Georgescu-Roegen, Nicholas, (1971), The Entropy Law and the Economic
Process, Cambridge, MA: Harvard University Press.
Gigerenzer, G. and R. Selten (eds) (2001), Bounded Rationality: The Adaptive
Toolbox, Boston: MIT Press.
Goldstone, J.A. (1998), Initial conditions, general laws, path dependence, and
explanation in historical sociology, American Journal of Sociology, 104
References
135
(3), 829-45.
Goodin, Robert E. (1998), Institutions and their design, in Robert E. Goodin
(ed.), The Theory of Institutional Design, Cambridge: Cambridge
University Press, Chapter 1.
Gosden, T. and D. Torgenson (1997), The effect of fundholding on
prescribing and referral costs: a review of the evidence, Health Policy, 40,
10314.
Green, Donald P. and Ian Shapiro (1994), Pathologies of Rational Choice
Theory: A Critique of Applications in Political Science, New Haven: Yale
University Press.
Greener, I. (2002), Understanding NHS reform: the policy-transfer, social
learning, and path dependency, Governance, 15 (2), 16183.
Habermas, Jurgen (1984), The Theory of Communicative Action, Volume 1:
Reason and the Rationalisation of Society, London: Heinemann.
Habermas, Jurgen (1987), The Theory of Communicative Action, Volume 2: A
Critique of Functionalist Reason, Cambridge: Polity Press.
Hacker, J.S. (1998), The historical logic of National Health Insurance:
structure and sequence in the development of British, Canadian, and US
medical policy, Studies in American Political Development, 12, 57130.
Hacker, J.S. (2002), The Divided Welfare State: The Battle Over Public and
Private Social Benefits in the United States, Cambridge, MA: Cambridge
University Press.
Hall, Peter A. (1993), Policy paradigms, social learning, and the state,
Comparative Politics, 25 (3), 27596.
Hall, Peter A. (2003), Aligning ontology and methodology in comparative
historical analysis, in James Mahoney and Dietrich Rueschmeyer (eds),
Comparative Historical Analysis in the Social Sciences, Cambridge:
Cambridge University Press, pp. 373406.
Hall, Peter A. and R.C.R. Taylor (1996), Political science and the three new
institutionalisms, Political Studies, 44 (4), 93657.
Hall, Peter A. and R.C.R. Taylor (1998), The potential of historical
institutionalism: a response to Hay and Wincott, Political Studies, 46 (5),
95862.
Ham, Christopher (1992), Health Policy in Britain, Basingstoke: The
MacMillan Press Ltd.
Ham, Christopher (1999), New Labour and the NHS, British Medical
Journal, 318, 1092.
Hamilton, W. (1996), Narrow Roads in Gene Land, vol: Evolution of Social
Behaviour, New York: Oxford University Press.
Harris, Conrad (ed.) (1996), Prescribing in General Practice, Oxford:
Radcliffe Medical Press.
Harrison, Stephen, David J. Hunter and Christopher Pollitt (1990), The
136
References
137
Kay, Adrian (2002), Devolution and drugs: the case for Welsh autonomy,
Policy and Politics, 30 (2), 18798.
Kay, Adrian (2003), Path dependency and the CAP, Journal of European
Public Policy, 10 (3), 40521.
Kay, A. and Robert W. Ackrill (2006), Historical institutionalist perspectives
on the development of the EU budget system, Journal of European Public
Policy, 13 (1), 11333.
Kemp, P. (2001), Housing benefit and welfare state retrenchment in Britain,
Journal of Social Policy, 29 (2), 26379.
Kenway, Peter (1993), From Keynesianism to Monetarism: Evolution of the
UK Macroeconometric Models, London: Routledge.
Kerr, P. (2002), Saved from extinction: evolutionary theorising, politics and
the state, British Journal of Politics and International Relations, 4 (2),
33058.
Kingdon, John W. (1984), Agendas, Alternatives and Public Policies, New
York: Longman.
Klamer, Arjo and Thomas C. Leonard (1994), So whats an economic
metaphor?, in P. Mirowski (ed.), Natural Images in Economics,
Cambridge: Cambridge University Press, pp. 2055.
Klein, Rudolf (1995), The New Politics of the NHS, London: Longman.
Klein, Rudolf and P. Day (1992), Constitutional and distributional conflict in
British medical politics: the case of general practice 19111991, Political
Studies, XL, 46278.
Labour Party (1995), Renewing the NHS: Labours Agenda for a Healthier
Britain, London: Labour Party.
Lakoff, George and Mark Johnson (2003), Metaphors We Live By, Chicago:
Chicago University Press.
Lawson, Nigel (1992), The View from No.11: Memoirs of a Tory Radical,
London: Transworld Publishers Ltd.
Lawton, V. (1999), Pharmaceuticals: from regulations to competition, Public
Money and Management, 19 (4), 46.
Levinas, Emmanuel (1994), Outside the Subject, Stanford, CA: Stanford
University Press.
Lewis, P. (1996), Metaphor and critical realism, Review of Social Economy,
54, 487506.
Lindner, J. (2003), Institutional stability and change: two sides of the same
coin, Journal of European Public Policy, 10 (6), 91235.
Lipsky, Michael (1980), Street-Level Bureaucracy: Dilemmas of the
Individual in Public Services, New York: Russell Sage Foundation.
Little, Daniel A. (1991), Varieties of Social Explanation: An Introduction to
the Philosophy of Social Science, Boulder, CO: Westview Press.
Luce, T.R.U. (1987), Thirty years of pharmaceutical price regulation:
138
References
139
140
References
141
142
HMSO.
Webster, Charles (1998a), NHS Reorganisation: Learning from History,
London: Office of Health Economics.
Webster, Charles (1998b), The Politics of General Practice, in I. Louden, J.
Horder and C. Webster (eds), General Practice Under the NHS 19481997,
London: Clarendon Press.
Wendt, Alexander (1999), Social Theory of International Politics, Cambridge,
MA: Cambridge University Press.
Wildavsky, A. (1964), The Politics of the Budgetary Process, Boston, MA:
Little, Brown.
Williams, Alan (2004), What could be nicer than NICE?, Office of Health
Economics, Annual Lecture.
Williams, Bernard (2002), Truth and Truthfulness: An Essay in Genealogy,
Princeton, NJ: Princeton University Press.
Wilsford, D. (1994), Path dependency, or why history makes it difficult but
not impossible to reform health care services in a big way, Journal of
Public Policy, 14, 25183.
Wilson, Edward O. (1975), Sociobiology: A New Synthesis, Cambridge, MA:
Harvard University Press.
Wilson, Geoff A. and Olivia J. Wilson (2001), German Agriculture in
Transition: Society, Policies and Environment in a Changing Europe,
Basingstoke: Palgrave.
Wistow, Gerald (1992), The health service policy community, professionals
pre-eminent or under challenge?, in D. Marsh and R. Rhodes (eds), Policy
Networks in British Government, Oxford: Clarendon Press, pp. 21935.
Index
agent behaviour
EU member states 102
in institutions 3940, 44, 45, 49, 52,
667, 70, 71
path dependency 3940
in policy paradigms 64, 71
public policy 32, 567, 61, 648,
6970, 96, 102, 105, 1089, 120
representative agent models 67
Australia
budget-making process 7
Goods and Services tax 46
industrial relations reforms 267
bandwagon effects 45, 52, 68
Baumgartner, Frank and Bryan Jones 2,
10, 26, 44
Brussels Agreements 857
budget systems see under EU
change 56, 11, 12, 91
incremental 436
radical 436
reductionism 43, 45, 65
and stability 3740
see also evolution
Collingwood, R.G. 20, 66
Crouch, C. and H. Farrell 3940, 55
Darwin, Charles 43, 47, 48
decision-making
EU budget system 88
and path dependency 336
public policy 11, 13, 256, 29, 55,
567, 88
Denmark, and EU CAP 100
dynamic analysis
and agents actions 567, 648,
6970, 96, 102, 105, 1089, 120
definition of 13
and history in social sciences 18, 20,
21
interactionist view 910, 56, 57
methodological localism 40, 64, 67
narrative elements 60, 63
policy as choice 249, 55, 65, 68, 118
and punctuated change 44
in social sciences 3, 45
and state space 45, 29, 8081
see also individual case studies
Easton, David 8
economics
evolutionary see evolution
hysteresis 68
increasing returns processes 40
neoclassical 4041
path dependency 2930
representative agent models 67
thrift paradox 24
Elster, Jon 1819, 20, 23, 28, 47, 62, 68
EU
and CAP see EU CAP
and GATT 87, 93, 96, 978
and Single European Market 85, 91,
99
telecommunications policy 21
EU budget system
Balanced Budget Rule (BBR) 78, 79,
815, 87, 89, 93, 95
bankruptcy avoidance 79, 85
Brussels Agreements 857
Budgetary Discipline 85, 86
and CAP see EU CAP
Compulsory Expenditure (CE) 78, 82,
84, 87, 88, 923
crises 7980, 82, 83, 84, 85, 87, 95,
100, 102
decision-making procedures 88
development 834
domain constraints 78, 82, 86, 87, 88,
96, 97, 102
143
144
Index
EU Treaty of Rome 39, 78, 79, 81
Articles 38 to 43 91
Article 39 934, 99
Article 199 81
Article 203 82
evolution
artificial selection 51
bandwagon effects 45, 52, 68
biological 43, 44, 45, 47, 49, 50, 51,
523, 578
fitness 523
functional explanations 47, 4850
incrementalism 436, 55
and intentionality 5052
metaphor 545, 567, 7980, 82, 83,
105
metaphor in EU 7980, 82, 83
myopia 51
narrative explanation 5, 28, 29
natural selection 47, 49, 50, 523, 57
network effects 45
optimization models 53
perspectives 4258
in policy studies 548
as a process 436
random variation 51
in social sciences 4753
as theory 468
tipping points 45, 52, 68
see also path dependency; public
policy
firms
efficiency of 34
routines in 47
see also institutions
Fontainebleau Agreements 845
France, and EU CAP 100, 102
game theory 2, 25, 105
Prisoners Dilemma 1089, 111
GATT
Blue Box policies 97, 98
and EU 87, 93, 96, 978
Green Box policies 97
Germany, and EU CAP 95, 100, 101
Habermas, Jurgen 56
Hall, Peter A. 11, 12, 20, 30, 32, 36, 65,
67, 70, 105
145
146
147
Index
classical view 89, 11
cluster concept 5960
combinational effects 40
as composite variable 21, 67, 90
contestation, continued 72
contingent conjunctures 278, 36, 60,
63, 65
cost-benefit analysis 67
crises 69, 7980, 82, 83, 84, 85, 87,
95, 100, 102
cycle 89
decision-making process 11, 13, 256,
29, 55, 567
definition of 2, 710
dynamic analysis see dynamic
analysis
and electoral competition 72
and evolution see evolution
failure 55, 105
folk theorems 112, 115
future constraints, anticipation of 52
generic stages model 5
government department operating
procedures 13, 30
government selfinterest 27
hinge propositions 1112
historical institutionalist (HI) school
20, 30, 37, 38, 47
history 23, 67, 21, 60, 72, 73, 120
ideal-type 5960
increasing returns processes 356
incrementalism 44
individual contracts 35
inefficient 41
and inertia 7
institutions see institutions
intention and action, distinction
between 257, 52, 55
interactionist view 910, 56, 57
and interest groups 35, 72
learning 55, 1056
memory 6871
meso-level concept 60, 64
metaphors 23, 28, 30, 356, 545,
567, 61, 73, 79, 122
methodological localism 64, 67
narratives see narratives, policy
neoclassical analysis 70
networks 13, 30, 35, 64, 108
paradigms see policy paradigms
148
111, 112
secondary care services 113
What the Doctor Ordered 114
Working for Patients 107
UK health policy 21, 23, 31, 38, 51, 104
BMA 1079, 110, 111, 112
community breakdown 11011, 112
Health Act (1999) 125, 127
Hospital Trusts 120
National Health Service Act 1946 108
National Institute for Clinical
Excellence (NICE) 116, 125,
126, 128
The New NHS: Modern, Dependable
11516
NHS funding 105, 11011, 116, 123
NHS internal market 106
NHS Plan (2000) 116
NHS policy paradigm 104
NHS reforms (1991) 105, 106, 114
NHS, two-tier 110
paradigm, breakdown of 1056
policy learning in healthcare 1056
politicization of 105, 1078
Primary Care Trusts 11516, 120
public demand for health care 105,
112
Royal Commissions 107, 109, 110,
111
trust in 109
UK pharmaceutical policy
annual financial return (AFR) 121,
122
and Audit Commission 124
brand name selling 125
branded products 124, 125, 126, 127
companies, support for 11819
demand-side policies 123, 125
DoH Pricing and Supply branch 120,
126
generic subscribing 115, 1234, 127,
128
and gentlemans agreement regulation
metaphor 121, 122, 123
and GP fundholding see UK GP
fundholding
interest groups 126
layering 121
limited list prescribing 110
marketing 121
Index
NHS drug procurement 11819
and NICE 125, 126, 128
overprescription of drugs 118
Pharmaceutical Price Regulation
Scheme (PPRS) 118, 120, 121,
122, 1234, 1257, 128
policy inheritance 120
policy instruments, increase in 121,
124
and policy paradigm 119
postcode rationing 126, 128
Prescription Analysis and Cost Data
(PACT) 123
price competition 124, 125
price regulation 126
profit targets 121, 122
public demand for drugs 126
149