Discourses on Modernization in the Employment Public Services: Towards a New Form of Governance?

The “crisis of the social issue” in the EU has led to a certain consensus in the need to renew the organizational and institutional model of public administration. The core of the reform implies important administrative changes in most of the European welfare states. Those changes are inspired on theories such as the new public management, management by objectives or partnership. Such changes involve both semantic (“sharing responsibilities”, “effective costs”, or the substitution of “citizen under an administration” by “consumer”) and political (predominance of scattered forms of power and the individualization of responsibilities) transformations which operate in the framework of individuals and State relations. The paradigms of activation and flexicurity have been central in this public administration modernization project. This commitment with new forms of governance of social issues has important consequences for the political and moral foundations of social cohesion, and the Spanish case is not an exception. This paper aims at looking at those representations of “modernization” (as they appear in debates about the employment services restructuring policies) in detail as well as providing references to the trajectory of such reforms of public services since the early eighties to the beginning of the crisis.

Citizens’ attitudes toward public services. Satisfaction in 2009-2011

The aim of this paper is to study the recent changes on citizens’ satisfaction with the performance ofpublic services, in the period 2009-2011 in Spain. Using data from the surveys on Quality of PublicServices, developed by the Sociological Research Center jointly with the National Agency for theEvaluation of Public Services and Quality of Services, our results show that the level of satisfactionhas slightly increased, which seems to display a greater tendency to positively value public servicesduring economic retrenchment. A major determinant of high satisfaction is self-reported ideology.Besides, immigrants display higher levels of satisfaction than Spaniards.

Making the law accessible to non-lawyers: effects of different kinds of expertise on perceived usability of online legal information services

To help design an environment in which professionals without legal training can make effective use of public sector legal information on planning and the environment - for Add-Wijzer, a European e-government project - we evaluated their perceptions of usefulness and usability. In concurrent think-aloud usability tests, lawyers and non-lawyers carried out information retrieval tasks on a range of online legal databases. We found that non-lawyers reported twice as many difficulties as those with legal training (p = 0.001), that the number of difficulties and the choice of database affected successful completion, and that the non-lawyers had surprisingly few problems understanding legal terminology. Instead, they had more problems understanding the syntactical structure of legal documents and collections. The results support the constraint attunement hypothesis (CAH) of the effects of expertise on information retrieval, with implications for the design of systems to support the effective understanding and use of information.

A delphy study of the cooperativisation of the social services in the historical territory of Gipuzkoa

This article shows the main results obtained from the Delphi study, which was made of politicians and technicians from the Department of Social Policy in the County Council of Gipuzkoa, concerning the possibility of cooperativizing the provision of social services in this historical territory. With this in mind, the structure of this article is in two different parts. The first part develops the theoretical framework which serves as inspiration for the empirical work, where note is made of the main theoretical proposals that have a bearing on the collective dimension of citizen participation in the management of public services. Among the various models, those which prioritise public participation through social and solidarity economy entities stand out. The second part concerns itself with the presentation of the field research results. To this end, the methodological notes concerning the preparation process for the Delphi analysis are presented first and this is immediately followed by a synthesis of the main results obtained in this study. The article ends with a section of conclusions and future lines of action.

Are gatekeepers to renal services referring patients equitably?

Objective: Patients with chronic kidney disease (CKD) benefit from specialist interventions to retard progression of renal failure and prevent cardiovascular events. Certain patient groups have poor access to specialist renal services when dialysis is required. This study used a population-based laboratory database to investigate access to and timeliness of referral to renal specialists relatively early in the course of the disease.

Methods: All tests for serum creatinine and haemoglobin (Hb) A1c in Northern Ireland in a two-year period (2001 and 2002) were retrieved for 345,441 adults. Of these, 16,856 patients had at least one serum creatinine level above 150 µmol/L in 2001 not deemed to be due to acute renal failure (crude prevalence 1.42%). This cohort was followed until the end of 2002 and the differences in the time to referral to a specialist were assessed using Cox's proportional hazards regression.

Results: Diabetic patients, older patients and those living in deprived areas were significantly more likely to have serum creatinine testing, compared with non-diabetic, younger and those living in more affluent areas. Delays in referral to renal specialists for patients with raised serum creatinine levels were significantly shorter among diabetic patients, women, younger individuals, those living in rural areas, those living close to renal centres and those living in deprived areas. Overall, only 19% of diabetic patients and 6% of non-diabetic patients who had CKD had seen a renal specialist within 12 months of their index creatinine test.

Conclusion: Contrary to other diseases, disadvantaged patients do not seem to be under-investigated for renal disease compared with their more affluent neighbours and are generally referred earlier for specialist assessment. However, the absolute rate of timely specialist assessment is low. Recent changes in referral criteria for CKD will result in more referrals and will have serious resource implications. Opportunities for health gain among patients with declining renal function are being missed, particularly among the old and those living furthest from specialist centres.