In this article, we discuss how regulation of governance in healthcare has been shaped over the past decade. We describe the presuppositions under this movement. Searching and balancing was needed to meet the complexity of care management. This has to do with the fact that the external pressure on the regulator after incidents is high. Due to this pressure, it is necessary to constantly ensure that management-oriented regulation does not narrow to the supervision on the actor with final responsibility. The regulation of good governance requires reflectivity of the inspectors and is aimed at stimulating recoupling between management and shop floors. This requires space for experimentation for both managers and inspectors. To provide this space, we do not only need a political and social debate about the quality of care and its management, but also attention and appreciation for the difficult considerations of organizing care.

In the 1990’s, the Dutch social democrats were trailblazers of what became known internationally as the politics of the Third Way, a new middle course between social democracy and neoliberalism. From the start, the Dutch Third Way distinguished itself from its Anglo-Saxon counterparts by its implicit character. The Dutch social democrat party (Partij van de Arbeid, PvdA) never fully embraced the Third Way and has sought to downplay the idea of a break with traditional social democratic thinking, combining Third Way practice with more classical social democratic rhetoric. The resulting political ambiguity, this paper argues, is at the centre of the present identity crisis of the social democrat party. Even though Third Way ideology has at times been declared dead, the range of attitudes, strategies and policy proposals that were introduced under its banner, still play a vital and prominent role in Dutch politics. While in the UK and the US, communitarianism was from the very beginning a defining feature of the Third Way, in the Netherlands this only came to the fore in 2012 under the leadership of Samsom and Asscher, and in the plea for a participation society under the Rutte II government. Leading us to conclude that the reports of the Third Way’s death are greatly exaggerated.

Since 2001, the Dutch province of Overijssel has had its own knowledge centre focusing on urban society, called the ‘KennisInstituut Stedelijke Samenleving’ (KISS), alongside national knowledge centres. This essay gives an overview of some relevant KISS meetings devoted to a many kinds of citizen participation. The overview is based on reports made by the author himself. Examples of citizen participation are: the new styles of neighbourhood governance, citizen participation through neighbourhood budgets, the strength of the city and location-based leadership, innovative urban renewal and the promotion of citizen initiatives in the province of Overijssel. Examples are not only from the province of Overijssel (situated in the east of the Netherlands), but also from other parts of the Netherlands and other countries (Flanders, United Kingdom, United States and all over the world). The subject of citizen participation (in connection with urban renewal and administrative leadership) enjoys an ever-increasing popularity as is shown by the number of KISS meetings devoted to this subject.

Citizen participation is firmly on the agenda of many Western policy makers. Numerous opportunities for individuals to participate in public decision-making have been created. However, few citizens use these opportunities. Those who do are often the highly educated, white, middle and upper classes that also tend to dominate other democratic spaces. Opportunities to become active can increase inequalities in terms of whose voices are heard in public decision-making. This fundamentally challenges the central democratic value of equality. Nevertheless, others can represent the interests of those who remain silent. Using the concept of representative claim this paper explores a variety of forms of representation (electoral, formal non-electoral and informal self-appointed) in the domain of social policy which is currently decentralized in the Netherlands. We conclude that especially informal self-appointed representatives such as medical professionals, churches and patient organizations can potentially play an important role in representing groups who often remain unheard in the public debate. They can therefore play an important role in ensuring the democratic quality of the decentralization process.

In 2010 the Netherlands Institute for Social Research (SCP) concluded that the Social Support Act (Wet maatschappelijke ondersteuning, Wmo) is successful as it leads to greater coherence in policies, and because the public Wmo-advisory councils are satisfied with the role they play. Wmo councils provide solicited and unsolicited advice to municipalities. They defend citizens’ interests against those of health care providers and insurance companies. Despite the positive results of the SCP study, there is an ongoing debate about the restyling of the Wmo-councils to increase their influence on local policy making. Some studies even call for a national council to prevent bargaining between the Associations of Dutch Municipalities (VNG) and the Ministry of Health, Welfare and Sports (VWS).

In this exploratory article, the authors analyse the influence of five local Wmo-councils - Alkmaar, Delft, Kerkrade, Tilburg and Utrecht - on local policy making. They examined the recognition and authority of these five councils and studied if municipalities heeded their advice. The article shows, that Wmo-councils themselves are dissatisfied with the influence they have. Subsequently, it demonstrates that municipalities anticipated the actions of Wmo-councils but hardly ever changed their policies accordingly. Wmo-councils are meant as a horizontal counterweight but are in danger of not being taken seriously.

A main motive for policy decentralization is the belief that municipalities are better able to customize public policy to local circumstances, and to realize made-to-measure service provision. In this respect, the introduction of the Social Support Act (Wmo) is an interesting example. With the lack of ‘vertical’ accountability obligations to the national government, the Wmo is governmentally innovative. Whether the decentralization results in customized forms of social support is a fascinating one because a detailed reading of the Wmo and its implementation displays possible incentives as well as barriers to made-to-measure service provision. The empirical exploration in this article uses data from the 2007-2009 evaluation of the Wmo conducted by the Netherlands Institute for Social Research (SCP). The evaluation shows that municipalities involve diverse stakeholders in formulating Wmo policy, and that their involvement seems to lead to customized service provision. At the same time, municipalities follow nationwide models, and information provided by the central government seems to have a major impact on local social care policy. The article concludes with an outlook on future directions in local debates on social care and the recommendation to give time for major decentralization trajectories such as the Wmo.

The growing interest in demand-based delivery is to be comprehended regarding the criticism on the traditional 'apply-based' delivery. Regarding the literature, the main stream notion on demand-based delivery contains the transfer of the tasks and duties from the intermediate professional to the client. Consequently, the (demanding) client is directly able to affect the provisions he is eligible to and to influence the acquirement of the services and goods.

The main issues are:

This article focuses on the new role of intermediate professionals. The intermediate professional can maintain a role in realising the demand-supply relationship between the client and the supplying professional; he can get the task to acquire and spread the required market information, but as well can get the responsibility to support the market participants using this information. In the same time, this responsibility can help to avoid the normative risks, especially the risk of inadequacy.

This new role must probably be regulated and in any case be monitored to prevent from the situation that the intermediate professional will take over the new responsibilities of the client. If this does not happen, the transfer to the demand-based delivery of public services will fail. On the other hand, if their will be no accessible client support by the new intermediate professional, the transfer to the demand-based delivery will tarnish the fundaments of the social system.

'Demand-based organising' has become popular throughout public domains, sometimes complementing, sometimes working against 'fact-based' and 'market-based' organising. This raises critical questions, about ways in which 'customer' and client demands are and can be known, and how multiple demands can be aggregated. In addition, it is difficult to link demand-based strategies to public service contexts, full of professional practices. How do public managers cope with such contradictory conditions? How can they organise in demand-based ways, amidst contradictory demands? This article, firstly, explores how demand-based rhetoric and instruments have been introduced. Secondly, it explores how public managers really (can) work in demand-based settings. Thirdly, it explores how demand-based practices can be organised, so that public service contexts can be managed 'professionally'. This leads to a paradoxical conclusion. Professional public managers organise in demand-based ways by not handing-over or 'outsourcing' content to customers and clients, but by substantiating demands themselves.