From politics to good management? Transforming the local welfare state in Italy

Abstract

In light of recent welfare reforms associated with new forms of managerial and financial accountability, this paper analyses the significance for the construction of new legitimate forms of governance of the relationship between public managers of welfare provider units and local elected politicians. The shift from local government as democratic representative institutions to depoliticised efficient agent of welfare provision has created in Italy the opportunity for the emergence of a new cadre of managers, less subject to interference by the parties. The increasingly problematic relationship between managers and politicians reflects the dynamics of a shifting game, originally intended for sector-specific interests, that was later transformed into a struggle between political elites across territory and about territorial politics. Any set of alternatives juxtaposing efficient management and politics is best viewed by taking account of the significance of local welfare institutions for political legitimacy.

Acknowledgements

I am indebted to my research colleagues at the Sonderforschungsbereich 597, Staatlichkeit im Wandel, Bremen, Germany, and to two anonymous referees, for useful comments. I am particularly grateful to Professor Stephan Leibfried for his encouragement and facilitating scholarly work in this area. Work on this paper was made possible by the material support received from the T.H. Marshall Research Fellowship, Department of Social Policy, LSE (2005–06).

Notes

1. Regional Law No. 31, Regione Lombardia, 11 July 1997, ‘Norme per il riordino del Servizio Sanitario regionale e sua integrazione con le attività dei servizi sociali’.

2. Tuscany enacted Regional Law No. 49 on 26 June 1994, ‘Norme per il riordino del Servizio sanitario regionale’. This law was abrogated by Art.139 of Regional Law No. 22 in 2000. In Emilia-Romagna, two implementing laws were passed: Regional Law No. 19 of 12 May 1994, ‘Norme per il riordino del Servizio sanitario regionale’, and Regional Law No. 50 of 20 December 1994, ‘Norme in materia di programmazione, contabilità, contratti e controllo delle Aziende sanitarie locali e delle Aziende ospedaliere’.

3. The deliberation of the regional Giunta of Tuscany No. 155 of 18 March 1992 had established that a distretto be of the size of a municipality. Regional Law No. 49/1994 had established that a distretto should not be smaller than 15,000 inhabitants. This value has been increased to 45,000 by the most recent regional health care plan 2002–04 (Section 6).

4. Regional Law No. 22/2000, Regione Toscana. In general, the role of the manager of the zona was strengthened by this law. It gives the manager budget autonomy, co-ordinating responsibilities of all health care services of the zona, including hospitals, appointment of people in charge of local services and units.

5. The instrument of planning of the local health authority is called ‘Piano delle Attività Locale’, literally ‘Local Plan of Activities’. The PAL is formulated by the general management of the local health authority but inputs are received by the Conference of Mayors and the regional administration.

6. Article 7, ‘Natura ed organi delle ASL’, Regional Law No. 31 of 1997, Regione Lombardia.

7. The problem with this system is that local health authorities find it problematic to remain within the budget constraints of their per capita financial grant.

8. The government bill, regarding ‘Delega al governo per la razionalizzazione del Servizio Sanitario Nazionale e per l'adozione di un testo unico in materia di organizzazione e funzionamento del Servizio sanitario nazionale. Modifiche al decreto legislativo 30 December 1992, no. 502’, was approved by the Lower Chamber on 26 May 1998, then amended by the Senate on 22 September 1998, and finally enacted after the final revision of the Lower Chamber on 10 November 1998.

9. Dossier Provvedimento, ‘Delega per il riordino del Servizio sanitario nazionale’, Iter alla Camera, A.C. 4230-B-, No. 612/2, XIII Legislatura, November 1998, Camera dei Deputati, Servizio Studi.

10. The bill majority rapporteur in the Budget Committee of the Lower House, Mr Sergio Chiamparino, Democrats of the Left, raised some concerns about the new financial burden resulting from the creation of the new regional co-ordinating institution (see Meeting of the V Permanent Budget Committee in the Lower House, 29 September 1998).

11. Decreto Legislativo 19 Giugno 1999, No. 229, regarding ‘Norme per la razionalizzazione del Servizio Sanitario nazionale, a norma dell'articolo 1 della legge 30 Novembre 1998, no. 419’.

12. Section 2, ‘Le politiche della Regione’, 1999–2001 Regional Health Care Plan, Emilia Romagna, states: ‘regional laws emphasise a strong orientation towards making more valuable the role of local government, not only as regards functions of control, but also general policy and evaluation of the activities of local health authorities’.

13. Article 15 of Regional Law No. 22 of 2000, Regione Toscana, establishes that the Permanent Conference of Health and Social Services Planning is a consultative body of the regional executive. It expresses an opinion on the proposal of the regional health care plan, on all bills regarding health care, on acts of concerted action between local health authorities, on guidelines produced by the regional Giunta for the formulation of implementing hospital plans and local plans.

14. Article 6, comma 9-bis of Regional Law No. 31 of 1997, Regione Lombardia, introduced the Permanent Conference as first established by the 1992 reform, which did not specify the functions and centrality of this institution. The 1997 regional law provides that the Conference's functions and composition be set out in deliberations of the Giunta.

15. Article 2, letter u), Law No. 419 of 1998.

16. Article 2 comma a) of the original bill (A.C. 4230) proposed ‘to strengthen the role of municipalities, in particular referring to regional health care planning activities, in the evaluation of the activities of general managers of local health care authorities, and also their dismissal’. Article 3 of the same bill proposed ‘regions to establish general criteria for the performance evaluation of general managers of local health care enterprises, with particular attention to the achievement of targets of regional planning’.

17. Minister Bindi, speech to the XII Committee of Social Affairs, Lower Chamber, 30 September 1998.

18. This point is made by many Senators of the opposition, such as Tomassini, Pardini, Bruni, XII Committee of Health Care, Senate, 16 June, 17 June, 23 June, 24 June, and 7 July 1998.

19. Interview with author, Rome, 16 July 2003.