This paper examines problems of setting targets for health care performance in which the centre sets a uniform set of targets and levels of performance. The case study examined by the paper is from the system of performance assessment of ‘star ratings’ that was introduced from 2001 by the Department of Health to give each organisation in the NHS in England a single summary score from zero rating to three stars. Star ratings were directed at holding trusts' chief executives to account for the local delivery of national priorities through a process of ‘naming and shaming’, in which Chief Executives of zero-rated organisations were at risk of losing their jobs. This paper outlines the underlying model and its three underlying assumptions: the centre can determine a scoring system to prioritise what matters; failures of performance that are not reflected in the scoring system do not matter; and the advantages of a system of scoring on accountable targets outweigh the disadvantages of various types of gaming responses. This paper examines the application of the model of star ratings to a case study of Primary Care Trusts (PCTs), which are complex organisations with three diverse sets of responsibilities: delivering primary care, commissioning secondary care, and supervising public health. It outlines an alternative model and the issues this raises for governance of health care performance.

Rival theoretical explanations of events and phenomena are common in economics, of which the Keynesian versus the monetarist debate is perhaps the best known. The traditional empirical procedure in economics has been to formulate a model from each theoretical framework and test each model's restrictions against observed data, rejecting or corroborating the specific model accordingly as the evidence is adverse or favourable. Although such an approach seems objective and scientific, it has two serious drawbacks: in practice neither rejection nor corroboration are definitive.

We investigate the effects of changes in taxes using the National Institute international macro model, NiGEM. A comparison on fiscal impulses worth 1 per cent of GDP for one year is made, with a comparison of a direct tax change, indirect tax change, and a lump sum payment. Multipliers are assessed one country at a time and when policy is coordinated to increase its impacts. We look at the importance of releasing borrowing constraints in a banking crisis. The analysis assumes financial and foreign exchange markets are forward looking.

The use of economic evaluation in relatively complex areas of health and social care has been limited. The level of complexity is influenced by the nature of the problems and interventions under evaluation, being dependent upon the degree of user involvement and the complexity of the inputs and outcomes. Complexity does not preclude the achievement of a good quality economic evaluation, but it can add significant difficulties. Efforts must be made to ensure scientific validity of evaluations, whilst recognising that the complexity inherent in many health and social care interventions may require deviations from and additions to traditional evaluation models. Fundamentally, the net effect will be the need for more time and money than would perhaps be required for the evaluation of a simpler intervention.

Age at entry to motherhood is increasingly socially polarised in the UK. Early childbearing typically occurs among women from disadvantaged backgrounds relative to women with later first births. The Millennium Cohort finds differentials in their children's development, cognitive and behavioural, at age 5, by mother's age. These could be due to difficulties facing immature mothers, but much of it is attributable to young mothers’ social origins, or inequalities apparent at the age 0 survey, which may also have had earlier origins. The developmental penalty left to be attributed to the mother's age per se is, at most, modest.

The high technical quality and reliability of Japanese manufactures raises questions of how the training and education of their workforce differs from Britain's. The standards reached by Japanese 15-18 year-olds in their technical and vocational secondary schools—and the number of pupils reaching them—are described in this paper and compared with Britain, as well as the standards reached in mathematics during compulsory schooling till 15. This article follows earlier studies of German and French schooling and vocational preparation (see this Review, August 1983, February and May 1985, and May 1986).

Japan … can hardly fail to become a teacher ere long. Alfred Industry and Trade, 1923.

The labour supply of teenagers in full-time education has been largely neglected in analyses both of the UK youth labour market and of educational decisions and policy. The teenage years have been seen as when a single transition takes place from full-time education to employment (or unemployment), in the form of a ‘school-leaving’ decision. The possibility that the transition from school to work may be more gradual, and involve a phase when school and work overlap, has been less discussed. Yet there are indications that the part-time work of teenagers in full-time education is a far from trivial aspect of teenage labour supply; an analysis of data from the Labour Force Survey for autumn 1992 (Sly, 1993) found that about one third of 16 and 17 year olds in full-time education also had a job, and that there were as many 16 and 17 year olds in full-time education who had jobs as there were school-leavers in work in the same age group.

The question whether the US equity market is overvalued is important from a policy perspective because a significant derating could interact adversely with the realisation of risks of recession. A simple dividend based model suggests that the market is two or three times overvalued. Allowing for stock buybacks, takeovers for cash and temporary unsustainable earnings growth leave the market overvalued by 20–30 per cent. The ‘New Economy’ view that recessions are things of the past and that technical change justifies permanently higher earnings growth is implausible. An influential argument that the traditional premium earned by equities over bonds is too high is itself theoretically special. Similarly the recent relationship between US inflation and the risk premium has not held at other times and places, while the fact that most wealth is held by middle-aged people with limited time horizons supports a larger premium. Our best guess is that the current premium is 1.7 per cent p.a. which is near the lower end of the historical range although equity investors do not appear to be prepared for lower returns in the face of the possibility of global recession in the next 12–18 months. The risk that a US market adjustment might aggravate such a recession in the US itself is a basis for reconsidering central banks' disregard of asset prices in setting monetary policy.

Two institutions have retarded UK productivity growth in the post-war period: industrial relations and education. The failings of both were largely addressed in the 1980s. The productivity improvement of the 1980s was genuine and was largely due to the reduction in union power brought about by the trade union legislation of the 1980s. The 1980s and 1990s have also seen large falls in the proportion of the labour force which is unqualified and rises in enrolment rates in further and higher education, changes which tend to increase long-run growth. But two factors have obscured the extent o f the improvement. First, the whole climate for economic growth is less favourable than it was in the so-called Golden Age prior to the first oil shock in 1973. Second, UK macroeconomic policy compares poorly with other OECD countries: booms have been shorter and recessions longer, so that microeconomic success has been masked by macroeconomic failure.

Social theorists frequently argue that social cohesion is under threat in developed societies from the multiple pressures of globalisation. This article seeks to test this hypothesis through examining the trends across countries and regions in key indicators of social cohesion, including social and political trust, tolerance and perceptions of conflict. It finds ample evidence of long-term declines in cohesion in many countries, not least as exemplified by the erosion of social and political trust, which is particularly dramatic in the UK. The trends are not entirely convergent, since on most indicators Nordic countries have become more cohesive, yet each country faces challenges. In the final section the authors argue that different ‘regimes of social cohesion’ can be identified in specific clusters of countries which are based on different cultural and institutional foundations. In the ‘liberal model’, which applies in the UK and the US, the greatest threat to cohesion comes not from increasing cultural diversity, but from increasing barriers to mobility and the subsequent atrophy of faith in individual opportunity and meritocratic rewards — precisely those beliefs which have traditionally held liberal societies together.

Almost all trade among industrial countries is now invoiced in the currency of one of the trading partners, normally that of the exporter. Use of a ‘third country currency’ (normally the dollar) is important only in trade with developing countries. Except for the decline in sterling's use as an international currency, there is no evidence that exchange rate expectations are a strong influence on traders' choice of currency.

In this article I consider shifts in the structure of wages in Britain between the mid-1970s and mid-1990s. In the 1990s the rising gap between the highest and lowest paid was either stable or rose a little, but by nowhere near as much as in the 1980s. This seems to be, at least partially, due to the fact that faster educational upgrading has dampened down some of the rising wage differentials experienced by the more educated. However, demand still seems to be shifting in favour of the more highly educated and skilled because, despite the fact that there are many more workers with higher educational qualifications, their wages relative to other groups have not fallen. Finally, I argue that relative demand shifts in favour of the more educated and skilled are still more pronounced in more technologically advanced industries. This is in line with the notion, like much of the evidence based on industry demand shifts in the 1970s and 1980s, that technology is key to changes in labour market inequality.

Rising immigration has undoubtedly been one of the most significant demographic developments experienced by the United Kingdom over the past fifteen years. This article reviews the evidence on the effects of immigration on the UK labour market. On average, it seems that immigration has not had much of an effect on either employment or pay. However, there may be some evidence of downward pressures on pay and jobs impact in the low skill sector, though these effects are not large.

This paper documents the fundamental changes in family formation that took place in Europe during the last two decades of the twentieth century, as well as some possible explanations for these changes. First, European youth have postponed key demographic events, and the latest-late pattern of transition to adulthood emerged in the South. Second, lowest-low fertility emerged during the 1990s in the same area, spreading quickly to Central and Eastern Europe. Policies and economic trends, long-standing cultural factors and ideational change interact in shaping change and differences. Macro-level factors in turn interact with micro-level ones to shape outcomes. The new demographic regime of Europe is thus likely to persist.

Over the course of the twentieth century housing wealth in the UK has risen dramatically; recently it has become easier for households to borrow against that wealth. The process by which real housing wealth has growth—through long-term increases in the relative price of homes and substantial real investment in the stock of dwellings—has implications for the impact of financial liberalisation upon saving future house prices and bequests of housing. This article takes a long-term perspective on housing in the UK in order to answer questions of great practical importance. The interaction between savings, population changes, bequests of properly, housing investment and house prices is analysed and the forces driving these variables into the next century are assessed.

This article analyses the properties of five leading macroeconometric models of the UK economy, in the light of the current discussion of monetary and fiscal policy-making. In simulation experiments, the interest rate and the basic rate of income tax are used to target the inflation rate and to ensure fiscal solvency. Our results show that monetary shocks soon affect the response of quantity variables, and fiscal shocks have monetary consequences, thus the operation of monetary and fiscal policy cannot be separated. Although the Bank of England's view is that it takes two years for monetary policy to have its maximum effect on inflation, our results show that this depends on the approach taken to the modelling of expectations.

European policymakers have repeatedly suggested that fiscal-policy coordination and fiscal federalism will play key roles in Europe's monetary union. This paper warns that this hope is misplaced. Fiscal federalism will not be available to offset recessionary shocks for the foreseeable future. The effects of coordination designed to internalise the cross-border spillovers of fiscal policies are too weak. Freeing up fiscal policy to replace national governments' loss of monetary independence requires allowing European countries' automatic stabilisers to operate. That in turn requires a flexible application of the Excessive Deficit Procedure and the Stability Pact.

The solution suggested here is that the Excessive Deficit Procedure and any fines and sanctions associated with the Stability Pact be applied to the constant-employment budget balance, not the actual deficit. Applying them to actual deficits when European countries enter EMU up against the 3 per cent limit will render fiscal policy strongly procyclical, aggravating the problem of macroeconomic fragility created by the loss of monetary autonomy. Still, countries like Germany haunted by the spectre of fiscal pro fligacy need to be reassured that member states will not abuse their fiscal discretion. Procedural and institutional reform to offset the deficit bias in national political systems is the obvious quid pro quo.

We investigate economic resilience of UK regions before, during and after the 2007/8 global financial crisis. We date business cycle turning points in real output, employment and productivity to assess the resilience dimensions of resistance, recovery and renewal and rank the economic resilience of regions in a resilience scorecard. Our empirical results reveal that the business cycle in productivity has not returned to its pre-recession peak level for Yorkshire and the Humber and the employment level has not recovered in Scotland. The resilience scorecard ranks the South East as the most resilient region with Northern Ireland the least resilient.