Can the state empower communities through localism? An evaluation of recent approaches to neighbourhood governance in England

‘Empowerment’ is a term much used by policy-makers with an interest in improving service delivery and promoting different forms of neighbourhood governance. But the term is ambiguous and has no generally accepted definition. Indeed, there is a growing paradox between the rhetoric of community empowerment and an apparent shift towards increased centralisation of power away from the neighbourhood in developed economies. This article explores the literature relating to empowerment and identifies two broad conceptions which reflect different emphases on neo-liberalism. It goes on to discuss two models illustrating different levels of state intervention at the neighbourhood level and sets out evidence from two neighbourhood councils in Milton Keynes in central England. In conclusion, it is argued that those initiatives which are top-down, state-led policy initiatives tend to result in the least empowerment (as defined by government), whereas the bottom-up, self-help projects, which may be partly state-enabled, at least provide an opportunity to create the spaces where there is some potential for varying degrees of transformation. Further empirical research is needed to test how far localist responses can challenge constraints on empowerment imposed by neo-liberalism.

Success, satisfaction and scrutiny: the business benefits of involving residents

This document summarises work to develop a compelling business case for landlord investment in resident involvement. Its key argument is involvement not only assists in improving satisfaction and service delivery, but also provides value for money.

The continuing popularity of the neighbourhood and neighbourhood governance in the transition from the 'big state' to the 'big society' paradigm

The neighbourhood in both the UK and Europe continues to dominate thinking about the quality of life in local communities, representation and empowerment, and how local services can be delivered most effectively. For several decades a series of centrally funded programmes in neighbour- hood governance have targeted localities suffering deprivation and social exclusion in England. From these much can be learnt about the strengths and limitations of a local approach to achieving multiple objectives.We review the findings of a case study of neighbourhood governance in the City of Westminster and draw on evaluations of two national programmes. In the conclusions we discuss the problems arising from multiple objectives and examine the prospects for neighbourhood governance as the national paradigm moves away from `big state' solutions towards the less-well-defined `big society' approach and the reinvention of `localism'. While the rationale for neighbourhood governance may change, the `neighbourhood' as a site for service delivery and planning remains as important now as in the past.

The potential for neighbourhood regeneration in a period of austerity: changing forms of neighbourhood governance in two cities

Localism is an active political strategy, developed in a period of austerity by the UK's coalition government as a justification for the restructuring of state-civil society relationships. The deprived neighbourhood has long been a site for service delivery and a scale for intervention and action, giving rise to a variety of forms of neighbourhood governance. Prior international comparative research indicated convergence with the US given the rise of the self-help conjuncture and the decline of neighbourhood governance as a medium of regeneration. The subsequent shift in the UK paradigm from ‘big’ to ‘small state’ localism and deficit-reducing cuts to public expenditure confirm these trends, raising questions about the forms of neighbourhood governance currently being established, the role being played by local and central government, and the implications for neighbourhood regeneration. Two emerging forms of neighbourhood governance are examined in two urban local authorities and compared with prior forms examined in earlier research in the case study sites. The emerging forms differ significantly in their design and purpose, but as both are voluntary and receive no additional funding, better organised and more affluent communities are more likely to pursue their development. While it is still rather early to assess the capacity of these forms to promote neighbourhood regeneration, the potential in a period of austerity appears limited. Reduced funding for local services increases the imperative to self-help, while rights to local voice remain limited and the emerging forms provide little scope to influence (declining) local services and (still centralised) planning decisions, especially in neighbourhoods with regeneration needs which are likely to lack the requisite capacities, particularly stores of linking social capital. Initial conclusions suggest greater polarity and the further containment of deprived neighbourhoods.

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight M, Acosta C, Brocklehurst P, Cheshire A, Fitzpatrick K, Hinton L, Jokinen M, Kemp B, Kurinczuk JJ, Lewis G, Lindquist A, Locock L, Nair M, Patel N, Quigley M, Ridge D, Rivero-Arias O, Sellers S, Shah A on behalf of the UKNeS coapplicant group. Background Studies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision. Objectives To (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts. Methods Mixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group. Setting Maternity units in all four countries of the UK. Participants Women with near-miss maternal morbidities, their partners and comparison women without severe morbidity. Main outcome measures The incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches. Results Women and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services. Limitations This programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded. Conclusions Implementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.

Service Quality in Arts Events: Operations Management Strategies for Effective Delivery

Recent debate on the quality of arts events has concentrated on the requirement to deliver against a complex range of political, social, and cultural criteria with an emphasis on the external partnerships that are forged. Yet those aspects of quality over which event organizers have more direct control have been accorded minor examination. The authors believe that operational effectiveness is key to service quality in the cultural context, and seek to demonstrate that a balanced consideration of both process and product is vital to fully deliver quality arts events. This article identifies areas of emergent research and practice and focuses on issues in the front-of-house environment where the breakdown of service quality is a real concern, using the experience of one UK not-for-profit arts organization as a case study to illustrate potential management responses.

London 2012: changing delivery patterns in response to the impact of the Games on traffic flows

The paper addresses road freight transport operations during the London Olympic and Paralympic Games in 2012. It presents work carried out prior to the Games to understand pre-Games patterns of freight deliveries in London (for both light and heavy goods vehicles) and the results of modelling work carried out to assess the likely impacts of the Games road restrictions on freight operations. The modelling results indicated that increases in total hours travelled carrying out collection and delivery work would range from 1.4% to 11.4% in the six sectors considered. The results suggested increases in hours travelled in excess of 3.5% in four of the six sectors modelled. The possible actions that could be taken by organizations to reduce these negative impacts were also modelled and the results indicated that such actions would help to mitigate the impact of the road restrictions imposed on operators during the Games. The actual impacts of the 2012 Games on transport both in general terms and specifically in terms of freight transport are also discussed, together with the success of the actions taken by Transport for London (TfL) to help the road freight industry. The potential freight transport legacy of the London 2012 Games in terms of achieving more sustainable urban freight transport is considered and the steps being taken by TfL to help ensure that such a legacy can be realized are discussed. Such steps include policy-makers continuing to collaborate closely with the freight industry through the ‘London Freight Forum’, and TfL's efforts to encourage and support companies revising their delivery and collection times to the off-peak; improving freight planning in the design and management of TfL-funded road schemes; electronic provision of traffic information by TfL to the freight industry, and the further development of freight journey planning tools.

Improving health and wellbeing independently of GDP: dividends of greener and prosoical economies

Increases in gross domestic product (GDP) beyond a threshold of basic needs do not lead to further increases in well-being. An explanation is that material consumption (MC) also results in negative health externalities. We assess how these externalities influence six factors critical for well-being: (i) healthy food; (ii) active body; (iii) healthy mind; (iv) community links; (v) contact with nature; and (vi) attachment to possessions. If environmentally sustainable consumption (ESC) were increasingly substituted for MC, thus improving well-being and stocks of natural and social capital, and sustainable behaviours involving non-material consumption (SBs-NMC) became more prevalent, then well-being would increase regardless of levels of GDP. In the UK, the individualised annual health costs of negative consumption externalities (NCEs) currently amount to £62 billion for the National Health Service, and £184 billion for the economy (for mental ill-health, dementia, obesity, physical inactivity, diabetes, loneliness and cardiovascular disease). A dividend is available if substitution by ESC and SBs-NMC could limit the prevalence of these conditions.