Over the last decades an increasing number of mergers and acquisitions between Dutch healthcare organizations has taken place (up scaling). More recently there is a rise in the numbers of new small-scale healthcare organizations and small-scale care facilities (down scaling in the numbers). The wide variety of scales, each with its pros, cons and (historical) contexts, makes the existence of one optimal scale an illusion. Our research question is: when, and on the basis of which values, is scale of healthcare organizations legitimate? We answer this question by analyzing 650 newspaper articles from fourteen national newspapers. By using theory about legitimacy and values, we argue that five values underlie the public discussion on scale: governance, the human size, quality of care, market power and efficiency. We conclude that achieving legitimate scale involves dealing with those five values, which are not always commensurable and sometimes conflicting. With this article we contribute to the scientific debate about scale and values. We also give recommendations to policy makers and executives that can be used to improve the legitimacy of scale decisions.

Urban government is expected to contribute to the solution of major urban problems. At the same time, urban government is riddled with problems itself, often denoted in terms of governing and democratic deficits. In this article, options for governance reform in the urban realm are being explored along five lines, following up on recent research in the Netherlands and abroad. Both more aggregative arrangements (electronic ‘straw polls’, knowledge polls, prediction markets, ‘dot gov’ competitions for ‘best solutions’) and more collaborative arrangements (electronic co-creation, wiki governance, vital coalitions, urban regimes) are being assessed. The conclusions is that there are good arguments for, at least, more experimentation along these lines - not only from a functionalistic, but also from a democratic and social-psychological point of view.

Deliberative democracy is a topic of fierce debate in political philosophy, democratic theory and other disciplines. Over the last two decades, the notion of deliberation - or dialogue - as a key democratic asset has also pervaded practices and empirical studies of public policy and governance. Although avid advocates and critics of deliberative governing and policy making may be found, the majority of scholars and professionals in this field take on a pragmatic, agnostic stance, and a public debate between them remains largely absent. Thus, deliberation is hardly contested or questioned, while in practice, it regularly leads to failure and disappointment. The article introduces and transcribes a dialogue on the failing of deliberation that was performed at a symposium on ‘Contested democracy’ by The Netherlands Organisation for Scientific Research (NWO) (Jan. 2011, The Hague). An optimist and a cynic deliberate the role of deliberation, accompanied by a chorus of administration scientists.

The problems discussed in the articles of this special issue are not merely wicked in the sense of involving normative dissensus and factual uncertainty. They also are systemic: they reflect institutional inertia, discursive inertia and the disruptive impact of sociological trends (individualization, Europeanization etc.) on incumbent practices and institutions. This systemic character tends to makes them persistent: while fundamental change is unavoidable, such change is likely to be bothered by the very institutional and discursive inertia it seeks to address. Reflecting, from a public policy studies point of view, on previous articles we deduce four principles from urban practices to deal with these challenges: 1) reduce dissent and uncertainty where possible; 2) acknowledge normative diversity by promoting context-specific solutions; 3) organize policies around societal/market initiatives that have emerged in a context and 4) define institutional changes that may further promote and simplify such policies and seize opportunities for structural change.

In 2010 and 2011 a committee of experts inspected if and how forty of the most deprived areas in Dutch cities have benefitted from the major national neighbourhood policy program launched by the previous government in 2007. The aim of the program was to restore living conditions in those areas within the next ten years, by investments in the physical, social and economic field, thus trying to improve the living conditions and chances (social mobility) of the neighbourhood citizens. According to the Committee, the forty neighbourhoods have proved to be laboratories for institutional change. There is growing confidence among local parties that with less disintegrated bureaucracy and more possibilities for citizen initiatives, interventions can be organised which are more effective and cheaper. Realising the objectives of the neighbourhood approach demands continuous involvement, effective organization, creative solutions and intensive contact between professionals and citizens. Government organizations and institutions need to relinquish control and facilitate and support the problem solving abilities of the professionals and citizens, who live and work in these neighbourhoods day in day out. In the most problematic neighbourhoods of Dutch cities, the seeds of the new welfare state are being planted.