Anne-Laure Beaussier

Mobilizing risk: explaining policy transfer in food and occupational safety regulation in the UK

Using comparative methods of policy analysis, this paper explores the institutional factors shaping the transfer and adaptation of risk-based approaches to regulation within and between the regimes for occupational health and safety (OHS) and food safety in the UK. Over the past two decades successive governments have enthusiastically promoted risk as a key concept for regulatory reform and ‘better regulation’. Rather than trying to prevent all possible harms, ‘risk-based’ approaches promise to make regulation more proportionate and effective by using various risk-based metrics and policy instruments to focus regulatory standard-setting and enforcement activity on the highest priority risks, as determined through formal assessments of their probability and consequences. But despite facing similar external pressures and sharing many historical and structural features as OHS, food safety regulation has proven much less receptive to risk-based reforms of its organizing principles and practices. To explain that anomaly, we consider a range of explanations highlighted in the policy transfer and mobilities literatures. We find that coercive drivers for the adoption of risk, in the form of top-down political pressure for deregulation or hard EU mandates, are much less influential than voluntary ones, which reflect both normative (ie, shared commitments to proportionality, resource prioritization, and blame deflection) and mimetic (ie, imitation of private sector corporate governance models) isomorphism. We conclude with wider reflections about the significance of our cases for policy transfer and mobilities research and for the limits to risk as a universal principle for organizing, and accounting for, governance activity. Keywords: risk governance, policy mobilities, food safety, occupational health and safety, risk-based regulation

Accounting for failure: risk-based regulation and the problems of ensuring healthcare quality in the NHS

In this paper, we examine why risk-based policy instruments have failed to improve the proportionality, effectiveness, and legitimacy of healthcare quality regulation in the National Health Service (NHS) in England. Rather than trying to prevent all possible harms, risk-based approaches promise to rationalise and manage the inevitable limits of what regulation can hope to achieve by focusing regulatory standard-setting and enforcement activity on the highest priority risks, as determined through formal assessments of their probability and consequences. As such, risk-based approaches have been enthusiastically adopted by healthcare quality regulators over the last decade. However, by drawing on historical policy analysis and in-depth interviews with 15 high-level UK informants in 2013–2015, we identify a series of practical problems in using risk-based policy instruments for defining, assessing, and ensuring compliance with healthcare quality standards. Based on our analysis, we go on to consider why, despite a succession of failures, healthcare regulators remain committed to developing and using risk-based approaches. We conclude by identifying several preconditions for successful risk-based regulation: goals must be clear and trade-offs between them amenable to agreement; regulators must be able to reliably assess the probability and consequences of adverse outcomes; regulators must have a range of enforcement tools that can be deployed in proportion to risk; and there must be political tolerance for adverse outcomes.

Intelligent Monitoring? Assessing the ability of the Care Quality Commission's statistical surveillance tool to predict quality and prioritise NHS hospital inspections

Background The Care Quality Commission (CQC) is responsible for ensuring the quality of the health and social care delivered by more than 30 000 registered providers in England. With only limited resources for conducting on-site inspections, the CQC has used statistical surveillance tools to help it identify which providers it should prioritise for inspection. In the face of planned funding cuts, the CQC plans to put more reliance on statistical surveillance tools to assess risks to quality and prioritise inspections accordingly. Objective To evaluate the ability of the CQCs latest surveillance tool, Intelligent Monitoring (IM), to predict the quality of care provided by National Health Service (NHS) hospital trusts so that those at greatest risk of providing poor-quality care can be identified and targeted for inspection. Methods The predictive ability of the IM tool is evaluated through regression analyses and χ2 testing of the relationship between the quantitative risk score generated by the IM tool and the subsequent quality rating awarded following detailed on-site inspection by large expert teams of inspectors. Results First, the continuous risk scores generated by the CQCs IM statistical surveillance tool cannot predict inspection-based quality ratings of NHS hospital trusts (OR 0.38 (0.14 to 1.05) for Outstanding/Good, OR 0.94 (0.80 to −1.10) for Good/Requires improvement, and OR 0.90 (0.76 to 1.07) for Requires improvement/Inadequate). Second, the risk scores cannot be used more simply to distinguish the trusts performing poorly—those subsequently rated either ‘Requires improvement’ or ‘Inadequate’—from the trusts performing well—those subsequently rated either ‘Good’ or ‘Outstanding’ (OR 1.07 (0.91 to 1.26)). Classifying CQCs risk bandings 1-3 as high risk and 4-6 as low risk, 11 of the high risk trusts were performing well and 43 of the low risk trusts were performing poorly, resulting in an overall accuracy rate of 47.6%. Third, the risk scores cannot be used even more simply to distinguish the worst performing trusts—those subsequently rated ‘Inadequate’—from the remaining, better performing trusts (OR 1.11 (0.94 to 1.32)). Classifying CQCs risk banding 1 as high risk and 2-6 as low risk, the highest overall accuracy rate of 72.8% was achieved, but still only 6 of the 13 Inadequate trusts were correctly classified as being high risk. Conclusions Since the IM statistical surveillance tool cannot predict the outcome of NHS hospital trust inspections, it cannot be used for prioritisation. A new approach to inspection planning is therefore required.

Comparer le Parlement européen et le Congrès américain. Un état des lieux théorique et méthodologique

Cet article s’interesse a la possibilite de comparer deux Assemblees considerees pour des raisons differentes comme « exceptionnelles » : le Parlement europeen et le Congres americain. Le mythe du deficit democratique de l’Union europeenne a longtemps ete alimente par des analyses soulignant la faiblesse du Parlement europeen. Cette assertion est toutefois aujourd’hui moins vraie. Depuis l’Acte unique, de profonds changements ont affecte cette Assemblee. Loin de confirmer la faiblesse de cette institution, les auteurs s’interessant a l’hemicycle strasbourgeois mettent en avant le role accru du PE dans le processus legislatif, suite notamment a l’extension du champ de la codecision. Le Congres americain a egalement longtemps ete considere comme une assemblee exceptionnelle en raison de l’etendue de ses competences legislatives. Cependant, les recentes evolutions connues par ce dernier, sous l’effet de la polarisation ideologique engagee depuis les annees 1980, tendent a rapprocher ses logiques de fonctionnement des parlements europeens. Ces considerations invitent a decloisonner l’etude de ces deux assemblees. La demarche suivie dans ce papier est double : elle propose d’abord une reflexion autour de l’integration de l’une ou l’autre de ces Assemblees dans un cadre comparatif, en s’interessant aux approches, methodes criteres mobilises et limites. Dans un second temps, elle s’attache a etudier la possibilite d’une comparaison entre le PE et le Congres.