Conclusions

This book is one of many dealing with the institutional changes and welfare reforms brought about by transformations in society. Unlike many others, though, it uses a distinctive and original principle – ‘subsidiarity’ – as a lens through which to examine and assess governance regimes, their philosophies and their organizational choices. Britain’s institutional and organizational reforms in health and social services undertaken since the 1990s were primarily designed with reference to the theory of quasi-markets, and aimed to challenge the traditional polarities of ‘market and state’, ‘private and public’, ‘supply and demand side’, upon which the modern welfare state had been built. Over the same period, Italy’s region of Lombardy undertook significant reforms explicitly and directly inspired by the principle of subsidiarity, also challenging those traditional, and increasingly obsolete, dichotomies of government. The main conclusion we draw is that the two systems, in spite of the similarities between them, are ultimately radically different. The UK quasi-market system can be summarized as a system where civil society (NGOs, quangos, etc.) helps the public sector in the delivery of services; in contrast, Lombardy’s subsidiarity-inspired model of governance sees the public sector help civil society to purse its own ends.