Regionalization is foregrounded among policymakers as a solution to the complex problems elderly care is facing, such as a pertinent staff shortage, a greying population and a lack of suitable accommodation. In this article, following a decentered approach, we analyze how field parties like nursing homes and policymakers in interaction give shape to regional collaborations within a market-oriented institutional healthcare context. Our findings show the emerging frictions, due to layered institutional arrangements and the proliferation of policy initiatives and partnerships. We find different responses of institutional actors to these frictions; actors holding off closer regional cooperation, actors creating urgency and commitment to organize care regionally, creating interstices in rules and regulations and building regional networks and care infrastructures. We argue that a focus on the iterative processes through which actors on different layers of the healthcare system give shape to policies adds a valuable perspective to the study of policy changes. We conclude that ‘layered work’ – mobilizing and working with and between different organizational and policy layers simultaneously – is required to develop appropriate (layered) ways to deal with complex problems.

Recently, the construction of large datacentres has led to intense societal debate in the Netherlands. Political decision making preceding the building of these centres is usually done at a decentralized governance level. However, at that level, it appears to be challenging to balance the relevant interest with integrity, and the living environment of citizens is easily overlooked. At the core of this debate lies a systemic challenge that comes with the changing role of the local government. Driven by privatization, globalization, digital transformation and citizen emancipation, the identity of governments transforms. Consequentially, governments are not only legislators and policy makers, but also – and increasingly – business partner, shareholder and client. Local politicians struggle with combining and switching between these roles. The case of datacentres is the embodiment of these challenges, and it takes a powerful, hybrid government to address these challenges in a meaningful manner and adopt a more active role for civilians in line with the new Dutch spatial planning law. Above all, it is necessary to focus on acting as a professional and stable partner. This is not only in the interest of citizens, but also in the interest of the related private organizations.

In 2019, the Financial Intelligence Unit of the Netherlands (FIU-the Netherlands) celebrated its 25th anniversary. This article uses the occasion to reflect on the pivotal role of the FIU in financial surveillance and to describe its core practices of collecting, analyzing, and disseminating financial intelligence. What makes an FIU particularly interesting is that it operates at various intersections: not only on the nexus of finance and security, but also between private and public actors, by transforming unusual transaction information into suspicious financial intelligence. Given this pivotal position of the FIU, it is surprising that little is known about its core activities. Because its practices are often secret and its data are classified as state secrets, its daily operations and operational processes remain obscure. By drawing on interviews, public reports, and an online training programme this article aims to encircle the secrecy, zoom in on the case-study of FIU-the Netherlands and offer a fine-grained analysis of each of the three core FIU activities. Such a case-study is important not only for the study of finance and security as well as financial surveillance, but also for policy makers and the broader public who merit an understanding of how their financial behaviour is being surveilled.

What causes the delays in the building of sufficient new homes in the Netherlands? And why do housebuilding projects so often struggle with financial feasibility? The land market typically can be described as an imperfect market, while the performance of the land and housebuilding market are closely connected. This connection seems to cause, at least partially, delays in the building of new homes. To be able to build new houses, ownership of land is crucial. However, land does not always come available in time. Landownership also influences competition in the housebuilding market. Based on a review of scientific literature, policy documents and empirical research results, this paper discusses the performance of the land and housebuilding market and its possible impact on housing production. Additionally, the paper reviews recent proposals that have been suggested in the context of the on-going Dutch housing market debate that may improve the functioning of these markets. What might be the effects of these interventions on housebuilding production? The paper concludes with a couple of dilemmas governments face with regard to the functioning of the land and housebuilding market.

Local policy freedom is often equated with the formal policy freedom of municipalities and thus with the formal boundaries that determine the local playing field. In this article, we question this approach. It is not clear to what extent formal policy freedom is a good measure for the ‘real’ policy freedom of municipalities, and thus for the policy freedom that municipalities use in policy implementation. Does more formal policy freedom necessarily lead to more used policy freedom? Moreover, not every municipality uses formal policy freedom in the same way. To indicate variance in policy discretion used, reference is often made to official capacity, scale and political changes. However, it is unclear to what extent these variables have an impact on local policy freedom. The authors investigate the link between formal and used policy freedom, official capacity, scale and political change on the basis of Flemish policy reform. Based on an analysis of financial data, they conclude that more formal policy freedom can be an incentive for more used policy freedom, but also that the explanatory power of administrative capacity, scale and political change is limited. In both research and policy, we need more attention for the value of social interaction, soft skills and networking.

Governments around the world responded at roughly the same time but in several different ways to the emerging threat of COVID-19 in early 2020. This article sets out the nature of the different strategies that emerged over the course of the pandemic, focussing on the policy tools deployed. Some of these efforts were successful in containing the coronavirus while others were not, in some cases due to poor initial choices and in others due to poor implementation of the chosen strategy. Although the initial understanding each government had of the nature of the disease was the same, different state capacities and different levels of preparedness and effective leadership can be seen to have resulted over time in the emergence of six distinct approaches to the pandemic which, once deployed, proved difficult, although not impossible, to change as the pandemic unfolded.

In June 2020, the Flemish populist radical right party Vlaams Belang (VB) published the Corona Blunder Book (CBB; Coronablunderboek in Dutch), detailing the government’s mistakes in handling the COVID-19 crisis. Populist parties can ‘perform’ crisis by emphasising the mistakes made by opponents (Moffitt, 2015) and may use a specifically populist discursive style, consisting largely of aggressive and sarcastic language (Brubaker, 2017). This paper takes the CBB as a case study in the populist performance of crisis and the populist style, finding that the book is, first, a clear example of populist ‘everyman’ stylistics and the performance of crisis, and, second, that VB uses the book to shift the COVID-19 crisis from a public health crisis to a crisis of governance, seeking to blame Belgium’s federal structure for the government’s alleged mismanagement of the COVID-19 pandemic and hence arguing for Flemish independence, one of the party’s main agenda points.

This article assesses the size and diversity of Belgium’s interest group population by triangulating four data sources. Combining various sources allows us to describe which societal interests get mobilised, which interest organisations become politically active and who gains access to the policy process and obtains news media attention. Unique about the project is the systematic data collection, enabling us to compare interest representation at the national, Flemish and Francophone-Walloon government levels. We find that: (1) the national government level remains an important venue for interest groups, despite the continuous transfer of competences to the subnational and European levels, (2) neo-corporatist mobilisation patterns are a persistent feature of interest representation, despite substantial interest group diversity and (3) interest mobilisation substantially varies across government levels and political-administrative arenas.

Healthcare is often dominated by the curative domain. Yet, for a new way of improving of and accounting for quality of care, we have to shift our focus to the care for people with disabilities. Since long, quality of care is translated into performance indicators and standards. This reductive way of measuring quality was pursued for the entire healthcare sector. Where this might fit in with hospital care, it was experienced as constraining in care for the disabled. In this sector it was seen as a poor representation of the plurality of healthcare provision. A number of ‘quality rebels’ aimed to create a more suitable and rich Quality Framework for the sector, with attention for objective, subjective and intersubjective dimensions of care. In this article, we analyze the way in which the sector has realized this aim, and we show how this rebellious sector succeeded in transforming the idea of accountability for quality of care, by emphasizing on the reflection and learning processes that take place at all levels of the sector, and beyond. A new approach which requires a continuous cycle of disrupting, creating, and maintaining institutionalized patterns of thinking and doing. It requires ‘rebel learning’.

Bureaucracy and ‘red tape’ are seen as a main annoyance in healthcare practice. ‘Rules’ like guidelines and performance indicators would withdraw professionals from their real work, that is, helping patients. However, rules may also improve quality of care if they foster high quality practices. In this research, we explore how healthcare rebels deal with rules in their everyday work: how rebels ignore, engender and bend rules to build new environments for doing good care. Drawing on ethnographic research in three hospitals in the Netherlands (2017-2018), we reveal how rebels build and care for clinical microsystems containing their own clinical unit and related contexts (e.g. pharmaceutical suppliers, ICT companies, primary care) to evoke alternative and situated practices of good care delivery – i.e. focusing on quality of life and person-centred care. Rebels enact mechanisms of decoupling and recoupling to disconnect rules that embark on good care in specific patient situations, and build new routines that foster good care. However, such caring practices are hard to generalize as they often occur ‘under the radar’ and hence remain hardly noticed to the outside world. We argue that through revising accounting processes, and paying more attention to narratives of good care, more convenient quality systems could be found.

The Dutch digital fraud detection system SyRI was announced to set up to detect social security fraud quickly and effectively and by doing so, maintain support for the social security system. It was the formal position that for the sake of effectiveness, no information about the algorithm and very limited information about the application of the system should be shared. The authors argue on the basis of a policy analysis, a legal exploration and a literature study that the lack of transparency about the chosen method and the application of the digital fraud detection system in social security can have far-reaching consequences for both the individual and society . The information sharing and the use of algorithms can lead to suspicion of and declining confidence in the government, and a reduced motivation to comply with the prevailing rules. This could undermine the original purpose.

This contribution analyzes the degree of relevance that administrators of independent administrative bodies (ZBOs) and agencies assign to their accountability relationships with social stakeholders. Although there is a lot of attention for social forms of accountability in the scientific literature, no large-scale quantitative research has been conducted into how administrators of implementing organizations experience this accountability. This study fills this gap on the basis of survey research by: (1) mapping the importance of forms and practices of social accountability for implementing organizations; and (2) weighing potential explanations for differences in the importance of social accountability in implementing organizations. The authors show that administrators of ZBOs and agencies in the Netherlands attach great importance to accountability towards their broad public environment, also compared to other countries with similar types of implementing organizations. This observation is in line with the Dutch reputation of consensual and interactive governance. Differences in the importance of social accountability between implementing organizations cannot be explained by the vertical accountability relationship with the parent department or other institutional organizational characteristics. The analysis shows that social orientation is greater among ZBOs and agencies where the media has more influence over administrators. Social accountability is associated with greater perceived media pressure.

The police use all sorts of information to fulfil their tasks. Whereas collection and interpretation of information traditionally could only be done by humans, the emergence of ‘Big Data’ creates new opportunities and dilemmas. On the one hand, large amounts of data can be used to train algorithms. This allows them to ‘predict’ offenses such as bicycle theft, burglary, or even serious crimes such as murder and terrorist attacks. On the other hand, highly relevant questions on purpose, effectiveness, and legitimacy of the application of machine learning/‘artificial intelligence’ drown all too often in the ocean of Big Data. This is particularly problematic if such systems are used in the public sector in democracies, where the rule of law applies, and where accountability, as well as the possibility for judicial review, are guaranteed. In this article, we explore the role transparency could play in reconciling these opportunities and dilemmas. While some propose making the systems and data they use themselves transparent, we submit that an open and broad discussion on purpose and objectives should be held during the design process. This might be a more effective way of embedding ethical and legal principles in the technology, and of ensuring legitimacy during application.

‘Nudging’ has been introduced as a policy and management tool as a way to influence behaviour without limiting choice. Nudging is mainly used to influence citizens’ behaviour but can also be used to influence the behavior of healthcare professionals. Examples include posters used to improve hand-hygiene compliance, or ‘default’ options in systems to reduce excessive prescriptions of specific medication. However, using nudges raises major worries and ethical issues, also in relation to the independence of healthcare professionals. While the scientific discussion about the desirability of nudges is extensive, the voices of healthcare professionals, who are the subjects of nudges, remain unheard. In this qualitative research we explore the perceptions of nudging held by various healthcare professionals. The interviews reveal that healthcare professionals are generally unfamiliar with the concept of nudging, but they do recognize nudges in their own field of practice. Furthermore, while they are predominantly positive about nudging, they also express concerns about the pressure on their autonomy. These concerns are related to changing professionalism and regulatory pressures in healthcare.

In 2003, the WRR suggested in the ‘Deciding on Biotechnology’ report that individuals should not be given ownership of their personal genetic information (DNA) to prevent risk selection and exclusion. Yet, that does not seem politically and ethically feasible. From that perspective, the research question of this article is how to regulate ownership and use of genetic information. Better predictability of health and longevity risk, through genetic information and thanks to new developments in geno-economics, possibly in combination with ‘big data’, makes risk selection by insurance companies attractive. That holds more specifically for the pension system. In addition to insurance for investment risk, the pension system also offers insurance for longevity risk. In itself, selection for longevity risk via premium setting is not unwarranted since the ‘bad risks’ with long life expectancy are the highly educated, so that the current implicit risk solidarity in pension insurance in The Netherlands, unlike in health insurance, brings about more inequality. But an unrestricted risk selection does raise ethical and social questions and does not fit into the new pension system in the Netherlands. That is why good and extensive legislation is needed for property rights and the utilization of genetic information of individual citizens. A similar focus on regulation is also in order for the use of DNA information of the government in criminal cases. Here the question is what additional options the government should have to use the information to solve crimes.

Recently, studies have burgeoned on the link between populism and demands for democratic reforms. In particular, scholars have been debating the link between populist citizens or voters and support for referendums. In this article, we examine voters of populist parties (Vlaams Belang (VB) and Parti du Travail de Belgique-Partij van de Arbeid (PTB-PVDA)) in Belgium in 2019 and we look at their attitudes towards various types of democratic reforms. We find that voters of populist parties differ from the non-populist electorate in their support for different kinds of reforms of representative democracy. Voters of VB and PTB-PVDA have in common stronger demands for limiting politicians’ prerogatives, for introducing binding referendums and for participatory budgeting. While Vlaams Belang voters are not significantly different from the non-populist electorate on advisory referendums, citizens’ forums or technocratic reform, PVDA-PTB voters seem more enthusiastic.