Effectiveness of Inter-Municipal Collaborations in the Social Domain

Effectiveness of inter-municipal collaborations in the social domain

Investigating the influence of structure-characteristics on an effective implementation of the Wmo

Author: D.L.G.C.W. de Ruijter Student number: 2005945

Master’s Thesis

Education: Public Governance Organisation: Tilburg University First reader: M.A. Verba Second reader: M.L.P. Groenleer Preface As a Public Governance student at Tilburg University I have written my Master Thesis with great joy and enthusiasm. I have investigated the social domain and specifically the Wmo. A policy field which is continuously changing, especially due to multiple different inter-municipal collaborations who are moving forward in making the decentralized task a success. Because the decentralisation of the social domain is relatively new (2015), I have noticed that collaborations continuously learn, adapt and make qualitative better policies.

I have met eight very enthusiastic respondents who work hard to improve the lives of citizens. Their work is important to stimulate citizens’ self-reliance and active participation in society, by providing customized support. I want to thank all respondents for their time and the effort they have spent in helping me with my project. I have travelled around the country to conduct the interviews and this has left me with very valuable information.

I also want to thank Michael Verba, assistant professor at Tilburg Institute of Governance (TIG) and Tilburg School of Economics and Management (TiSEM) for supporting me with my Master thesis. I have learned a lot these past three months and I will continue to monitor the progress of the social domain now and in the future, in which I hold very optimistic expectations.

Donné de Ruijter Meerlo, September 15, 2018

Abstract Since the decentralizations of tasks in the social domain in the Netherlands since 2015, municipalities cooperate in order to share knowledge, resources and risks. Municipalities have chosen different inter-municipal collaborations in order to implement these tasks. Therefore I have investigated the following research question:

How effective are different inter-municipal collaborations in the Netherlands in implementing the Wmo?

I have collected the data from document-analysis and interviews. I have talked with eight professionals in four different collaborations in the Netherlands. Inter-municipal collaborations outsource most activities to the market in order to provide the necessary care and support. The right set of procurement instruments are therefore required in order effectively regulate the market. Furthermore, I have investigated how structure characteristics facilitate integral policy making, client participation and how knowledge and expertise are accumulated.

I can conclude that cooperation leads to a bigger market with more competition between providers, which lead to efficiencies and more freedom of choice for clients. A joint procurement policy leads to efficiencies as a result of an increase in expertise and staff savings, which is also necessary in order to provide specialised care. Collaborations who benefit from legal personality and who have formal negotiating structures can facilitate integral policy making and can attract the right expertise. This improves effectiveness because these collaborations can provide basic services as well as additional services. Collaborations that do not have formal negotiating structures or jurisdictions can experiment and learn from different interventions in one region. Nevertheless, this can lead to multiple complex negotiating structures which are perceived as ineffective.

Keywords: Inter-municipal cooperation, Social Domain, Social Support Act (Wmo), Procurement, Integral Policy-making, Effectiveness.

Word count: 20.522

Table of Contents 1. Introduction ...... 6 1.1 Reading Guide ...... 8 2. Theoretical discussion ...... 9 2.1. Inter-municipal cooperation ...... 9 2.1.1. Administrative models ...... 9 2.1.2. Legal forms ...... 9 2.1.3. Agreements ...... 11 2.2. Procurement Management Tools ...... 13 2.2.1. Inter-municipal cooperation ...... 13 2.2.2. Tender method ...... 13 2.2.3. Funding method ...... 15 2.2.4. Clients’ freedom of choice ...... 15 2.2.5. Contracts: duration, extension and flexibility ...... 16 2.3 Inter-municipal cooperation and effectiveness ...... 17 3. Methodology ...... 21 3.1. Data collection ...... 22 3.2. Validity and reliability ...... 24 4. Results ...... 25 4.1. Wmo ...... 25 4.2. ROG plus ...... 27 4.2.1. Organisational structure ...... 27 4.2.2. Tasks and jurisdictions ...... 27 4.2.3. Motives for collaborative form ...... 28 4.2.4. Accumulating knowledge and expertise ...... 28 4.2.5. Client and citizens’ involvement ...... 29 4.2.6. Integral policy making ...... 29 4.2.7. Effectiveness ...... 29 4.2.8. Procurement and contract management ...... 30 4.3. Region Gooi and Vechtstreek ...... 31 4.3.1. Organisational structure ...... 31 4.3.2. Tasks and objectives ...... 32 4.3.3. Motives for collaborative form ...... 33 4.3.4. Accumulating knowledge and expertise ...... 33

4.3.5. Client- and citizen involvement ...... 33 4.3.6. Integral policy-making ...... 33 4.3.7. Effectiveness ...... 33 4.3.8. Procurement and contract management ...... 34 4.4. Social Domain Achterhoek ...... 35 4.4.1. Organisational structure ...... 35 4.4.2. Tasks and objectives ...... 35 4.4.3. Motives for cooperation ...... 36 4.4.4. Accumulating knowledge and expertise ...... 36 4.4.5. Client- and citizen’s involvement ...... 36 4.4.6. Integral policy-making ...... 36 4.4.7. Effectiveness ...... 37 4.4.8. Procurement Management Tools ...... 37 4.5. Central Municipality Brabant North-East ...... 38 4.5.1. Organisational structure ...... 38 4.5.2. Tasks and objectives ...... 38 4.5.3. Motives for cooperation ...... 39 4.5.4. Accumulating knowledge and expertise ...... 39 4.5.5. Client- and citizen involvement ...... 39 4.5.6. Integral policy-making ...... 39 4.5.7. Effectiveness ...... 40 4.5.8. Procurement Management Tools ...... 40 5. Analysis ...... 41 5.1. Cooperation characteristics ...... 41 5.2. Conditions for effectiveness ...... 43 5.3. Management Tools Procurement ...... 46 6. Conclusion ...... 49 6.1. Discussion ...... 51 References ...... 52 Appendices ...... 56 Appendix I: Email to municipalities ...... 56 Appendix II: Interview questions ...... 57 Appendix III: Document analysis ...... 59

1. Introduction Willem Alexander, king of the Netherlands introduced the concept of the ‘participation society’ in his annual speech in 2013. From that moment on, the dominant welfare state would be changed into a participation society in which active, responsible citizenship is emphasized. A reason for this is to contain the rising costs of healthcare in the Netherlands and the government deficit, by which 11 billion euros have to be paid on interest every year. In order to keep a sustainable standard of public services, citizens should take on a more leading role in their own lives and in their environment. Therefore the government has decided to decentralise three tasks in the social domain (Ministerie van Algemene Zaken, 2013).

The reason for the decentralisation is due to the information position of municipalities; which- compared to the national government- have more information about local circumstances and client specific needs. Therefore, municipalities can develop more specific health assessments, which improve allocative efficiency (Besseling, Hers, Hoekstra, Lamers, Mosca, & Okker, 2013).

Consequently, since January 2015, municipalities are responsible for executing three pillars within the social domain. The pillars of the social domain are the Youth Law (in Dutch: Jeugdwet), Participation Act (in Dutch: Participatiewet) and the Social Support Act (in Dutch: Wet Maatschappelijke Ondersteuning), also abbreviated as Wmo (Ministerie van BZK).

The administrative and financial transfers of tasks since 2015 are also referred to as the transition- phase (van der Ham, 2018, p. 39). In this phase, the aim was to guarantee the same level of care and other social provisions for clients (Janssen, van der Bent-Crezee, Huurneman, & Smeets, 2016, p. 1).

The transformation-phase includes sustainable executing practices of municipalities with core objectives such as fostering the self-organising capacity and active participation of clients by providing customized services. This means a new way of organising care, support and other social provisions (van der Ham, 2018, p. 39). The national government expects that municipalities work together if that is necessary for an effective implementation according to article 2.6.1. Wmo 2015.

Nevertheless, municipalities are relatively free as to how they want to structure their cooperation (Ministerie van BZK). Municipalities, then, have to decide how they want to relate to each other and secondly, in which collaborative form they want to realise their ambitions (Janssen, van der Bent- Crezee, Huurneman, & Smeets, 2016, p. 1).

Reasons for cooperation are to increase (cost-) effectiveness, strengthen strategic policy development, decrease vulnerability of individual municipalities, increase the executive power and efficiency and uphold a strong position during negotiations with stakeholders (Janssen, van der Bent- Crezee, Huurneman, & Smeets, 2016, p. 1).

In this study I will refer to inter-municipal cooperation (IMC), “when at least two or more decentral governments cooperate and when cooperation is documented with at least one of the involved participants” (Theissen, Westerbeek, & Noordink, 2017, p. 9). In 2017, KWINK-Group and PROOF- advisors have made a dataset about all inter-municipal collaborations in the Netherlands. Within the social domain there are 313 collaborations, from which 168 within the Participation Act, 80 within the Social Support Act and 65 within Youth-Law (Theissen, Westerbeek, & Noordink, 2017, p. 50). I have used the dataset to develop figure 1.

In figure 1, the x-axis represents the three pillars in the social domain and the y-axis represents the number of collaborations for each category. Categories cover multiple different options for cooperation, which I will elaborate on in paragraph 2.1. These categories are based on a report of the VNG which is also used by KWINK group and PROOF advisors. I will discuss these categories briefly.

An independent organisation is a new established formal organisation in which jurisdictions and competences are transferred in a new cooperation, which includes legal personality, and is therefore able to hire people and close contracts. A network-cooperation is less formal, jurisdictions can be transferred, but cooperation can also be based on contracts or agreements. Adjustment is the least formal way of collaborating: it can be based on agreements, contracts or a shared vision (de Greef , Theissen , & de Voogd, 2015, pp. 17-18).

140 125 120

100 Independent 80 Organisation 60 Network 32 40 29 31 26 20 23 Adjustment 20 14 13 0 Participation Act Youth-Law Social Support Act

Figure 1: distribution of collaborations within the social domain

The relatively large amount of independent organisations within the Participation Act is due to the necessary competences that are required: most municipalities execute this task by establishing government companies for supporting citizens with a distance to the labour market (Theissen, Westerbeek, & Noordink, 2017, p. 50). Therefore the competence is needed to hire people and close contracts. Another reason is that all competences and jurisdictions are automatically transferred when municipalities choose to collaborate in a Public Body (Article 8c Participation Act, 2018).

The diversity of different collaborations within the Youth-Law and the Wmo is due to more outsourcing activities, by closing contracts with healthcare providers (Theissen, Westerbeek, & Noordink, 2017, p. 50). 93% of the municipalities work together on joint procurement (van der Ham, 2018, p. 54). Municipalities can regulate the market with procurement instruments, such as tender methods and funding methods (van Eijkel, 2018, p. 5). In this study I will focus on the Wmo, because a relative equal amount of municipalities choose different collaborative forms in order implement the Wmo.

But what, then, are the consequences of these different inter-municipal collaborations on the implementation of the decentralized task in the Wmo? How do different collaborations answer the objectives from the Wmo and how do they regulate the market in order to guarantee an effective output of care, support and other provisions? Therefore I have developed the following central research question:

How effective are different inter-municipal collaborations in the Netherlands in implementing the Wmo?

Two aspects represent effectiveness in the Wmo, namely the set of procurement instruments that are used in order to regulate the market by influencing price, quality and clients’ freedom of choice. Furthermore, there are some conditions for effectiveness which are based on the law and the most recent empirical findings. I could denote the capacity of an IMC to provide an integral service level as one of the most important indicators that reflect effectiveness in the Wmo. I will develop some specific indicators that reflect these aspects which will be used to collect the data from four different cases. I will use literature and recent empirical findings to define and operationalise these aspects and indicators. The data will be collected with document analysis and interviews.

Furthermore, different inter-municipal collaborations differ in administrative and legal foundation. Consequently, this will influence the structure of an IMC. I will elaborate on all options for cooperation which are made possible through public law and private law. I will use the law and the literature to discuss the possibilities and limitations of each form of cooperation. The dataset will be used in order to develop some indicators which reflect the structure of the IMC. The data will be gathered via document analysis. How effectiveness is perceived is gathered via the interviews.

1.1 Reading Guide In chapter 2, I will present multiple options for inter-municipal cooperation in the Netherlands which are made possible through public law and private law. Furthermore, I will discuss multiple procurement instruments that collaborations can use in order to regulate the market and create an effective output of care and provisions. Finally I will discuss literature about the relationship between inter-municipal collaborations and effectiveness. I will develop some theoretical assumptions about this relationship.

In chapter 3, I will present three aspects in order to investigate the influence of different structure characteristics on effectiveness. These aspects are based on the theoretical framework. Furthermore I will elaborate on the methods that have been used in this study and will discuss validity and reliability.

In chapter 4, I will start by elaborating on the Wmo, its objectives and the conditions for effectiveness that are based on the law and the most recent empirical findings. Furthermore I will describe the results from four different inter-municipal collaborations, namely the Social Domain Achterhoek which is an informal cooperation based on a Shared Vision, ROG plus which is a Joint Body with an executing Foundation, the Region Gooi and Vechtstreek (RGV) which is a Public Body and finally the Central Municipality Oss.

In chapter 5, I will discuss and compare the results in our analysis by developing three tables which correspond with the three aspects that I investigated. I have connected the three tables in which all four cases are included. We will use the literature in order to clarify the analysis.

In chapter 6, I will elaborate; to what extent our findings correspond with the theoretical assumptions. Furthermore, I will answer the central research question. I will also elaborate upon the limitations of this study and will make some recommendations for further research.

2. Theoretical discussion First I will discuss multiple administrative models and the corresponding legal options to structure cooperation. Next, I will outline multiple procurement instruments in order to regulate the market. Finally I will elaborate on the relationship between collaborations and effectiveness and will develop some corresponding theoretical assumptions about this relationship.

2.1. Inter-municipal cooperation First I will outline some different administrative models which reflect how municipalities can relate to each other. Next I discuss multiple options for cooperation. I will use the Joint Provisions Act (in Dutch abbreviated as WGR) to discuss public law collaborations and will also discuss private law collaborations. Furthermore, I will discuss public and private agreements. Finally I will connect the different administrative models to the legal possibilities for cooperation.

2.1.1. Administrative models Municipalities can have different reasons for collaborating. The important thing to do before choosing any legal form is to determine how municipalities want to relate to one another. Linze Schaap distinguishes three administrative models.

In a network-model, municipalities share knowledge in an informal way. The employees remain employed within their own municipality, but there is a structural cooperation between the municipalities, for instance within a taskforce. Nevertheless, there are no tasks, jurisdictions nor employees transferred within this type of cooperation (Schaap, 2015, pp. 146-147).

Tasks can also be shared within a matrix-model. Within this model, all municipalities are responsible for a restricted amount of tasks or policy areas, and also execute these tasks for the participating municipalities. Employees who deal with a certain task are mainly appointed to the municipality which is responsible for the relevant task, which results in integration of official expertise for every policy area. The decision-making authority remains with every single participating municipality. In this way, every municipality fulfils a central role for the other municipalities (Schaap, 2015, p. 147).

Taking a next step, the integration-model entails a merger of the civil service, in order to execute tasks or policy areas; if not, all areas. Consequently, a new civil service is established; the participating municipalities can close contracts with this new civil service. There are three examples of the integration-model. First of all, municipalities can concentrate officials within one Central Municipality, who execute a task or a policy area for the other municipalities. Secondly, municipalities can integrate some of the organisation in a shared service centre (for instance a joint procurement agency). Lastly, participating municipalities can merge their entire official capacity in a new civil service (Schaap, 2015, p. 147).

2.1.2. Legal forms Inter-municipal collaborations can be based on public law and private law. Public forms are possible through the Joint Provisions Act (in Dutch abbreviated as WGR). The WGR distinguishes five forms.

The Public Body, which is established in article 8 (1) WGR has legal personality, which makes it possible to close contracts, hire people and to possess capital. Just like other Public Bodies in the Netherlands- like the national government, provinces and municipalities- a new Public Body for inter- municipal cooperation, has a day-to-day management, a general management and a chairman.

Jurisdictions for developing general binding regulations can be transferred to this new Public Body, and in turn, this new Public Body can also be used for pooling the civil service in a new organisation (Schaap, 2015, pp. 148-149). After establishment, it becomes possible to grant mandates. These decisions can be revised; on the contrary, decisions based on delegation cannot be revised. Councillors, aldermen and mayors can participate within a Public Body (VNG, 2015).

The Joint Body, article 8, (2) WGR, only has an executive board, which necessitates a robust supervision of the participating municipalities. Nevertheless, the competence to grant permits- like a permit which gives a citizen certain rights for care and support- can be delegated to a Joint Body (VNG, 2015). This form is suited for accomplishing relatively simple objectives, which do not require legal personality. Jurisdictions cannot be delegated to a Joint Body (Schaap, 2015, p. 149).

Furthermore, in article 8 (3) WGR, municipalities can also choose the Business Management Organisation. This form of cooperation is only suited for supporting- and executive tasks. But this form does have legal personality, which makes it possible to hire people and to perform other legal acts (Schaap, 2015, p. 149).Only aldermen or mayors can establish and participate in an business management organisation (VNG, 2015).

Besides establishing a new organisation, cooperation based on the WGR is also possible in a Central Municipality. The participating municipalities, then, designate one municipality as a Central Municipality for executing certain jurisdictions on behalf of those participating municipalities. The Central Municipality represents the other municipalities in that aspect. However, formal jurisdictions remain within the participating municipalities. The relation between the host-municipalities and the Central Municipality is based on mandate. This makes it possible to withdraw or to revise the mandate (VNG, 2015).

Finally, there is an arrangement implicitly possible within article 1 WGR. This is an agreement without using any of the previously discussed forms. It is an agreement between cooperating governing bodies, without establishing a specific legal form. Therefore no jurisdictions can be delegated from one municipality to the other (Schaap, 2015, p. 149). Examples are gentlemen’s agreement, covenants and governing agreements. Within these agreements, the nature of collaborating, the objectives and the motives are determined. It is Important to refer to article 1 of the WGR within these agreements, which makes it a public agreement. Otherwise it is not clear if the agreement is private or public in nature. Consequently it is, then, not clear to what extent the agreement is enforceable (VNG, 2015).

Besides Public law, there are also collaborations possible which are established in Private law. Private forms are based on private law (in Dutch: abbreviated as BW). Private forms are the Private company (in Dutch: BV), Limited Liability Company (in Dutch: NV), Corporations, Foundations and Associations.

A Private Company (BV) is a legal entity with a stock-divided public capital, where the shares are non- transferable (article 2:175, clause 1 BW). In general, the same rules apply to the Limited Liability Company (NV), but on the contrary, the shares are transferable (2:64, 1 BW) and the shareholders are not liable for the actions of the company. In reality, it commonly means that one can only lose the value of its share(s) in the company.

Intelligence- and information-sharing within a BV (article 2:217, 2 BW) and NV (article 2:107, 2 BW) is obligated within a general assembly of share-holders. The general assembly of shareholders designates the executive board of the BV (article 2:232, 1 BW) and NV (article 2:132, 1 BW), but is not required that the executive board comes from the general assembly.

An Association is a legal entity in order to achieve one or more goals (article 2:26, 1 BW), but those goals may not include the distribution of profit among the members (article 2:26, 3 BW). Within a Corporation, however, it is not prohibited to share the profit among the members (article 2:53, sub a BW). Every member within an Association (article 2:38, 1 BW) and Corporation (article 2:53, sub a BW) has voting rights within the general assembly. A Foundation only may distribute profit if the payments are for an ideological or social purpose (article 2:285, 3 BW). Finally, the executive board is designated by the general assembly (article 2:37, 1 and 2 BW).

Moreover, the Foundation is a legal entity, which does not have any members, but tries to achieve certain goals, which are established in statutes; accompanied with a predetermined capital (article 2:285, 1 BW). There are no voting-rights because a Foundation does not have any members, but only an executive board. It can, though establish- within its statutes- new committees on which voting- rights can be applied to (article 2:293 BW).

Van den Dool and Schaap have created a table which shows the match between the administrative models and the legal forms (van den Dool & Schaap, 2014, p. 70). The X refers to the fact that a legal form is appropriate for a particular administrative model.

Table 1: Legal collaborations and administrative models

Network-model Matrix-model Integration-model

‘Regeling zonder meer’ X X Central Municipality X X Business Management Organisation X X Common Body X Public Body X Private forms X X X

2.1.3. Agreements Finally, there are also some agreements possible for specifying objectives and/or implementation- practices within a cooperation.

A Jurisdiction-Agreement is a public law agreement between two or more parties about the usage or adjustment of certain public competences from governing bodies in order to achieve certain goals. A jurisdiction agreement is also known as a covenant (de Greef , Theissen , & de Voogd, 2015, p. 19). This form can be used for specifying the financial rules or rules to withdraw a mandate, such as within a Central Municipality (de Greef , Theissen , & de Voogd, 2015, p. 31).

In a Policy-Agreement, municipalities pursue certain objectives, and in order to achieve those objectives, they have to reach an agreement about how to use their private legal acts. Although general principles of good governance are applicable, this does not involve guarantees, like political accountability, publicness and the right of complaint (de Greef , Theissen , & de Voogd, 2015, p. 19).

Another agreement between municipalities is the Management-Agreement, in which no particular legal or administrative form is used. If this form is used in combination with a certain mandate, than this is referred to as a Central Municipality (de Greef , Theissen , & de Voogd, 2015, p. 51).

In private law, there is also a legal form possible through a Service-Agreement. This is an agreement in which one municipality performs tasks for another municipality. A service agreement is not a legal form as such, but can be based on agreement to assignment and is established in article 7:400 BW. A Service-Agreement can also denote an agreement within a Central Municipality or another form with legal personality.

The discussed private forms may only be established if it is deemed necessary to serve the public interest better than public forms. Accountability-measurements, information-sharing and transparency are arranged within public law and also measurements against misuse are guaranteed within public law. This should otherwise be separately arranged within private forms according to article 160, 2 Local Government Act. In figure 2 an overview is presented of all possible collaborations. I have connected the different collaborations to the categories as described in the introduction.

Figure 2: Overview Collaborations

To summarize, municipalities can collaborate in multiple public and/or private forms. The matrix- and integration models facilitate the more formal collaborative forms, in which competences and jurisdictions can be transferred. Within those collaborative forms, more soft additional collaborative instruments, like agreements, can be used for specifying objectives or the usage of particular competences or jurisdictions. These soft instruments can also be used autonomously; as the foundation of cooperation. It then depends to what extent agreements are fixed and to what extent these agreements are enforceable.

Inter-municipal cooperation is also an instrument to regulate the market of healthcare providers. I will now discuss this instrument and other procurement instruments.

2.2. Procurement Management Tools Collaborations outsource activities, provisions and support to the marketplace. This role has been investigated by the Central Plan Bureau (CPB) and the Public Procurement Research Centre (PPRC). Collaborations use the market due to the benefits of expertise, economies of scale and the disciplinary effect of the market. In order to use the advantages of the market, Collaborations have certain tools for an effective procurement policy. I will therefore elaborate on these tools (van Eijkel, van Ommen, & Uenk, 2015, p. 3).

2.2.1. Inter-municipal cooperation As mentioned in the introduction, inter-municipal cooperation is one of the instruments for an effective implementation of the decentralized tasks. Municipalities can increase their administrative power and uphold a strong position in negotiation procedures with providers. Furthermore, cooperation decreases transaction costs- on the supply-side as well as on the demand side-due to the fact that procurement is organised via one organisation. This is also attractive for providers due to a bigger market. On the other hand, collaborations have a democratic deficit and especially large collaborations are less innovative in their procurement methods due to low consensus building opposed to smaller collaborations (van Eijkel, van Ommen, & Uenk, 2015, p. 20).

Collaborations work more efficiently in the procurement process due to the fact that they share knowledge regarding care and procurement (van der Ham, 2018, p. 57). Furthermore, they provide standardization on a local level, because they commonly use the same product codes and prices. Especially small municipalities benefit from an increasing administrative power, because they lack the knowledge and resources (Uenk, 2017, p. 15).

2.2.2. Tender method Another instrument is the use of a tender method. The most commonly used method is administrative procurement in which a select amount of providers are invited for a plenary meeting to negotiate conditions. Those who can meet these general discussed conditions can enter a framework agreement (van Eijkel, van Ommen, & Uenk, 2015, p. 23).

Within the Zeeuws model, most conditions are predetermined by the municipality or cooperation; which lowers the administrative burden. Providers do not have to write a proposition and thus does not have to be reviewed by the IMC. Only the pre-set conditions and standards have to be met in order to enter a framework agreement. This model necessitates having insight in the production costs, because the prices are predetermined. Consequently, low prices can lead to a small amount of providers and limits the clients’ freedom of choice; high prices can lead to inefficiency, because inefficient providers can still survive in this model (van Eijkel, van Ommen, & Uenk, 2015, pp. 23-24).

Multiple private tendering also uses a limited amount of providers. They are selected and invited by the municipality, but still need to develop a proposition. The rest of the contract conditions are bilaterally negotiated (van Eijkel, van Ommen, & Uenk, 2015, p. 24).

An IMC can also use a public tender, in which providers can write a proposition about the services they can provide with a corresponding price. This increases competition and will consequently lead to a good balance of price and quality (van Eijkel, van Ommen, & Uenk, 2015, p. 24).

Best Value Procurement challenges providers to come up with creative ideas. The municipality has a functional attitude towards providers by adapting its demands to the providers’ proposition. Bilateral dialogues are commonly used in order to negotiate the quality of services (van Eijkel, van Ommen, & Uenk, 2015, p. 25).

Finally in a private auction, a select group of qualified providers are selected for a framework- agreement without guarantees of revenue. The agreements specify services with maximum prices. Providers, then, have to offer their services and prices on an online auction for every client. If the client does not have any preferences, than the client goes to the most cost-effective provider. The client’s preferences are not revealed on the online auction (van Eijkel, van Ommen, & Uenk, 2015, p. 25). In figure 3 an overview is presented about the distribution of tender methods that are used in the Wmo (Uenk, 2017, p. 16).

Percentage of Tender Methods 1% 3% 8% Administrative Tender Multiple Private Tender 17% Zeeuws Model 54% Public Tender

18% Beste Value Procurment Private Auction

Figure 3: Distribution Tender Methods Wmo

According to Professor Jan Telgen, tender is no longer mandatory, while this is the dominant thought of most municipalities and even the national government. Since the European Court verdict in 2016, if a client chooses a certain provider than a contract is sufficient. The advantages of a contract- opposed to a tender model- is more simplicity, less administration, a reduction of formal errors and also procedures and the accessibility are made easier for providers. On the other hand, municipalities have to adapt their business management to this open house model (Zorgvisie, 2018, p. 3).

2.2.3. Funding method P x Q financing is a method in which a provider receives a fixed price for every hour of service. This funding method is usually combined with a maximum budget, which can block efficiency and innovation. With a big budget, there is an incentive to deliver more hours of services; with a tight budget the danger of waiting lists may occur due to probable client stops. Nevertheless the costs can be reduced if cheaper employees are used. This commonly corresponds with the level of education and can therefore affect the quality of care (van Eijkel, van Ommen, & Uenk, 2015, p. 28).

Population funding means that (a consortium) of providers receive a fixed budget within a period of time for every inhabitant of a certain area (district). The provider is responsible for any surpluses or shortages which create an incentive to work efficiently. Good monitoring instruments are necessary in order to check if the budget is not too high. Decreasing the budget can block efficiency and innovation, but long-term contracts can overcome this threat (van Eijkel, van Ommen, & Uenk, 2015, pp. 28-29). Thus a very specific description of the results that need to be achieved is essential in order to make a corresponding funding method effective by improving quality, innovation and improving someone’s self-reliance and active participation in society (Uenk, 2017, p. 19).

Finally an IMC can also choose to give a fixed price per client. The provider has the freedom to provide the care that is needed and does not have to report his input. The results are central in this funding method which makes it possible to provide customized services, but also to work efficiently due to a fixed price. On the other hand, this is a soft incentive to decrease care volume and can lead to overproduction. Waiting lists are less likely to occur in this funding method (van Eijkel, van Ommen, & Uenk, 2015, pp. 31-32). In figure 4 the distribution of funding methods in the Wmo are presented (Uenk, 2017, p. 16).

Figure 4: Distribution Funding Methods Wmo

Percentage of Funding Methods

P x Q 30% Funding based on Results 64% Population Funding

2.2.4. Clients’ freedom of choice Another way to manage quality of services is to give the client freedom of choice. If the client gets the option to switch provider, than a provider needs to deliver quality which is not necessarily stipulated in contracts. Municipalities can facilitate this freedom by showing the achievements of all providers. This instrument can only be effective when there are enough providers to choose from and if the client is sufficiently capable to make a choice (van Eijkel, van Ommen, & Uenk, 2015, p. 38).

2.2.5. Contracts: duration, extension and flexibility Another way to manage performance is the option to extend contracts. Municipalities can learn about a providers’ performance in a certain period of time and can use this to determine the option for contract extension. Reputation is important for providers in order to get contracts in the future. This instrument is only effective when there is enough competition (van Eijkel, van Ommen, & Uenk, 2015, p. 41).

With contract duration of one year it is hard to reap the benefits from the investments; especially transaction-specific investments such as investigating client needs (or specific needs in a district) and to adapt the business management to the procurement methods of an IMC. Consequently, long-term durations can overcome insufficient investments; provided that contracts cannot unilaterally be changed. On the other hand, long term durations can increase market power and lead to a competitive advantage which makes an IMC more dependent of one or a select group of providers and thus decreases the collaborations’ negotiating power (van Eijkel, van Ommen, & Uenk, 2015, pp. 42-43).

Finally, flexibility in contracts can be an instrument to cope with unexpected threats from the environment. Nevertheless, tender law restricts the use of making substantial changes to contracts, because otherwise providers who did not win the tender or did not get a contract are disadvantaged, because they could have wrote another proposition with possible better outcomes (van Eijkel, van Ommen, & Uenk, 2015, pp. 46-47).

We will now discuss the relationship between inter-municipal cooperation and effectiveness. We will discuss the reasons why municipalities want to cooperate, the advantages and disadvantages of cooperation and how it influences effectiveness. We will also elaborate on the concept of effectiveness in public policy networks. Finally we will develop some theoretical assumptions about how cooperation influences effectiveness.

2.3 Inter-municipal cooperation and effectiveness The relationship between inter-municipal cooperation and effectiveness is best described within public policy network theory. Policy network theory argues that organizations are mutually dependent in order to achieve certain objectives. Hence multiple interactions occur about the distribution of resources, which leads to rules that regulate behaviour and in turn influence interactions in a network. These interactions create a context in which the actors act strategically (Klijn & Koppenjan , 2006, p. 139).

This strategic behaviour can lead to conflicts, because differences may occur in objectives and interests (Klijn & Koppenjan , 2006, p. 140). The assumption, then, is that policy outcomes are the consequences of these strategic interactions. This also creates power struggles; the rules can be coercive, can create blockades due to the actors’ resources, but also misperceptions can lead to conflicts or stagnation in the process (Klijn & Koppenjan , 2006, p. 143).This in turn, can lead to a reduced level of trust, which can lead to higher interaction costs.

Rhodes defines policy networks as: “sets of formal institutional and informal linkages between governmental and other actors structured around shared if endlessly negotiated beliefs and interests in public policy making and implementation. These actors are interdependent and policy emerges from the interactions between them” (Rhodes, 2006).

Rhodes distinguishes the power-dependence approach and the rational choice theory within the policy network theory. Power dependence constitutes the share of resources in order to achieve certain goals, and the mutual dependency of each other’s resources creates strategies which in turn lead to certain rules of the game. Policy outcomes, then, are the results of bargaining and negotiating within the game (Rhodes, 2006, p. 431).The rational choice theory claims that institutions influence the norms of resourceful and rational actors by which interactions among these actors shape policy outcomes (Rhodes, 2006, p. 432).

But why do municipalities cooperate? One of the main advantages of cooperation is scale; this leads to a bigger market in which the allocation of resources can be organised more efficiently (Schep, 2010, p. 9). Also, knowledge can be shared which leads to a higher quality of services and cooperation can improve marketing strategies. Finally investments and risks can be shared via cooperation (Schep, 2010, p. 10).

Another motive for cooperation is due to cross border problems. Besides tackling joint problems, risk-sharing is an advantage of cooperation; the probability of failure will decrease as a result of cooperation (Schep, 2010, pp. 11-12). Schep argues that cooperation failure does not directly relate to differences in policy objections, but more to coincidences and practicalities, (Schep, 2010, p. 13). Nevertheless, the same sense of urgency about important considerations is paramount for effective cooperation. This also means that a common vision about goals and levels of quality should be developed (Schep, 2010, p. 14).

Furthermore, cooperation can also lead to cost savings in staff expenses. Especially in small municipalities, civil servants perform multiple tasks at once, but if municipalities work together on one procurement plan for instance, than expertise and specialisation can be reached. Thus leading to cost savings regarding policy development, monitoring and controlling and reduces the need to hire external expertise; something especially small municipalities have to face (Schep, 2010, p. 31).

Another important feature for effective cooperation is trust. Trust is obtained via communication. It is important that in every layer and between multiple layers, there is effective communication. Also, communication with clients is important; after all, clients are the reasons for cooperation in the first place (Schep, 2010, pp. 38-39).

Tasks can be outsourced to other municipalities, but also to the market. When activities are outsourced to the market it is important to monitor the contract requirements in order to secure efficiencies, effectiveness and legality. The municipality still remains liable for the outcomes of outsourced activities (Schep, 2010, p. 45).

There are multiple arguments for boosting effectiveness of local policies via inter-municipal cooperation (IMC). The first one is due to economics of scale. In the social domain in the Netherlands, the decentralized tasks created the Example: Information- possibility to focus on individual needs. Information- sharing sharing is an important feature of economies of scale (Vermeulen , 2015, pp. 134-135). An example is presented An example of information- in figure 5. sharing are the district teams in which different professionals Scale also increases the bargaining power of participate: professionals have municipalities; providers can operate in a bigger market, knowledge about different which leads to more providers who want to sell their provisions which can tailor services and therefore increases the options of the IMC. integral provisions for client Another feature which improves effectiveness is sharing specific needs, but professionals costs and risks; especially small municipalities have who provide household-support difficulties in organising and financing specialised care. can also monitor mental Sharing resources among different municipalities can wellbeing of clients or can assess reduce uncertainty about expenditures (Vermeulen , 2015, other requirements that are p. 138). needed. This creates an incentive to invest in prevention and to Another way to view effectiveness in the field of regional intervene in an early stage which governance, are the monocentric and polycentric can lead to efficiencies. perspective. The monocentric view favours one regional authority who takes over tasks and responsibilities of municipalities in a region in order to effectively implement policies. Institutional consistencies- like national regulations- will reduce uncertainty, transaction costs and Figure 5: Example information sharing will foster effective cooperation. The polycentric view, on the other hand, favours the autonomy of each municipality to freely enter a cooperation in which the institutional design depends on local specific issues (Klok , Denters , Boogers, & Sanders, 2018, pp. 527-528).

Dutch reformers believed- in line with the monocentric view- that the Joint Provisions Act (WGR)- which gives a limited number of cooperation possibilities via public law- would foster a more uniform and simple structure of regional governance in the Netherlands. In turn, this would improve transparency and therefore would lower the transaction costs and improve effectiveness.

Transaction costs include all costs that are associated with negotiation, coordination, monitoring and controlling (Klok , Denters , Boogers, & Sanders, 2018, p. 529).

Determining the impact of cooperation on costs and effectiveness are: population size, complexity of structure characteristics and the collaborations’ regulatory regime. Population size determines the amount of resources; financial as well as the level of expertise. It turned out that small municipalities benefit from cooperation due to necessary extra resources in order to provide goods and services.

There is some weak support for polycentric view; complex networks have a slight positive effect on a reduction of the transaction costs. Finally the regulatory regime favours the monocentric view; uniform regimes tend to lower the transaction cost and improve the local and regional benefits (Klok , Denters , Boogers, & Sanders, 2018, p. 533).

Provan and Milward claim that public sector organizational networks have to be analysed on three levels in order to measure effectiveness. First of all effectiveness of networks have to be evaluated at an community level, which means that it has to be assessed to what extent the network provides services to the community which could not otherwise have been delivered by autonomous and uncoordinated organizations. Thus, the added value to the community has to be evaluated in order to measure effectiveness (Provan & Milward, 2001, pp. 416-417). Example: Integral services Secondly, if clients’ perceptions are translated into added When vulnerable youngsters value, than it will give legitimacy to the network, thus become 18, they are no longer effectiveness also has to be evaluated on a network level. subjected to the Youth-Law, but Effectiveness then is assessed by the services the network to the Wmo. Youngsters, then, provides that satisfy the actual needs of clients. This also suddenly are responsible for includes the capacity to provide basic services, as well as paying their rent, seek additional services (Provan & Milward, 2001, p. 418). An example is presented in figure 6. employment or education. Effectiveness then is not only to Furthermore, effectiveness is measured by multiplexity, provide basic provisions within which constitutes the amount of relationships within a each law, but to include multiple network and the strength of those relationships. Also the professionals in a network in administrative structure is important for effectiveness in order provide integral services. order to extract and distribute resources (Provan & Hence, effectiveness is to provide Milward, 2001, p. 419). care and support in the field of Finally, on an organisational level, effectiveness can be Education, Participation Act, assessed in which a network is able to extract resources Youth Law, Wmo and Housing and thus becomes attractive to organizations to enter the (Boonstra, 2017). network. Organizations will only enter a network when a better level of integrated services can be provided to their Figure 6: Example Integral services clients in a more effective and efficient way (Provan & Milward, 2001, p. 420).

Based on the theoretical discussion I expect the following relationships between inter-municipal cooperation and effectiveness.

 I expect that scale is an important factor for effective inter-municipal cooperation due to a bigger market which leads to more providers, share of resources and investments, share of knowledge and expertise and share of risks.  I expect that a same sense of urgency and a common vision are conditional for effective cooperation.  I expect that cooperation leads to reduced staff expenses due to specialisation and expertise.  I expect that communication leads to trusts and this leads to effective cooperation.  I expect that uniform ICM regimes reduce transaction costs and improve local and regional benefits.

Based on the theoretical discussion, in figure 7, an overview is presented of factors that will improve effectiveness as a result of cooperation in public policy networks.

Information- Cost savings sharing

Sharings risks Integral and policy resources making

Negotiating Scale Effectiveness power

Figure 7: Advantages of cooperation for effectiveness

Based on our theoretical discussion we have developed some indicators in order to collect the data from four inter-municipal collaborations in the Netherlands. We will discuss these indicators and the aspects in represents in the methodology.

3. Methodology I have chosen to conduct a qualitative research, in which situations, cases and phenomena are investigated in their natural setting (Gabrielian, Yang, & Spice, 2008, p. 142). I have used qualitative methods in which interpretation and understanding is emphasized rather than explaining or predicting (Gabrielian, Yang, & Spice, 2008, p. 143). The reason for this is due to the fact that inter- municipal cooperation in the Netherlands regarding the Wmo is relatively recent. There is little research about the interaction between structure characteristics and effectiveness. Therefore I want to describe how different collaborations implement the Wmo. In order to answer the central research question I have developed a conceptual model. Overviews of indicators, which reflect these aspects, are presented in table 2.

Cooperation characteristics

Effectiveness

Conditions Management for tools effectiveness procurement

Figure 8: Conceptual model

Effectiveness is the extent in which an IMC has the capacity to provide basic services and additional services. The aim of the Wmo is to provide customised services in order to improve clients’ self- reliance and active participation. This is reflected by conditions for effectiveness. The indicators which represent these conditions are outlined in paragraph 4.1.The structure of an IMC facilitates the extent in which integral services can be provided, namely via negotiation structures, the legal and administrative foundation of cooperation (what an IMC is allowed to do) and the amount of the involved policy fields. The actual provisions and integral services are mainly provided by the market. Therefore it is necessary to adequately regulate the market in order to influence price, quality and the clients’ freedom of choice.

Cooperation characteristics include specific structure characteristics. I have used the dataset of KWINK-Group and PROOF advisors for the development of these structure characteristics and to collect the corresponding data, because this is the most complete and recent dataset of all inter- municipal collaborations in the Netherlands (Theissen, Westerbeek, & Noordink, 2017, p. 11).

With these characteristics I can compare the results from the cases. I have also used document analysis in order to verify and complement the results from the dataset.

The structure influences the conditions that are set to have an effective implementation of the tasks in the Wmo. In the cases I will zoom in on these conditions and will describe how these conditions are implemented. Besides these conditions, specific procurement instruments (van Eijkel, van Ommen, & Uenk, 2015) are used in order to investigate how collaborations regulate the market. Therefore multiple indicators are included in order to investigate which set of instruments are effective.

3.1. Data collection For answering our central research question I have used case studies. I have investigated four different inter-municipal collaborations in the Netherlands, namely a Public Body, a Joint Body with an executing Foundation, a Central Municipality and an IMC that is based on a Shared Vision. I used the dataset to select the cases. I selected the cases in order to reflect the real composition in the Netherlands. Therefore I have selected one case within each category (independent organisation, network and adjustment). Furthermore I have selected cases within different regions in the Netherlands (rural and urban).

Cooperation Conditions for effectiveness Management Tools characteristics Procurement

Legal foundation Integral policy-making Tender method - administrative form - between different policy fields; - tasks and jurisdictions - between different governing bodies Participating Accumulation of knowledge and expertise Funding method municipalities - expertise in task or policy field - monitoring instruments - governing bodies - level of education/ professional background - scale employees Involved policy fields Development of innovation Clients’ freedom of choice - amount of innovations - how facilitated Motives Client- and citizen participation in policy- Contracts making - duration - amount of participants - extension - amount of proposals - flexibility - how supported/facilitated Table 2: indicators for data collection

The legal foundation indicates possible jurisdictions of an IMC, such as policy development, closing contracts and to possess capital. Correspondingly, tasks and jurisdictions indicate what an IMC is allowed or obligated (mandated) to do.

The participating municipalities represent scale but also the possibility to share knowledge, due to an increase of official expertise. Involved policy fields remain a separate indicator because an IMC can include policy fields inside as well as outside the organisation. Although motives are not a cooperation characteristic, they are included in order investigate the perceptions of respondents towards the (dis-) advantages of the IMC in which they operate.

Furthermore, I have analysed how these structure characteristics interact with the conditions for effectiveness. I will show how the different cases implement integral policies, how they facilitate citizen participation and to what extent innovations are developed or facilitated within each case. Also, I have analysed how structure-characteristics and conditions for effectiveness interact with procurement instrument in order to have an effective output of care and support.

The methods that I used to collect the data are desk-research and field-research. In appendix III, there is an overview of the documents that were used for our desk research. I have used documents in which the legal foundation of cooperation is established. With this information I have investigated the administrative model and legal foundation of cooperation, which governing bodies are involved, how many negotiation meetings are established and in what scale the IMC operates.

Policy documents are used to investigate which policy fields are involved, to what extent integral policies are made, how innovations are facilitated or developed, how citizens are included in decision making and how expertise is accumulated. Finally, procurement plans are investigated in order to analyse which set of procurement instruments are used.

Regarding field research, I have conducted eight interviews. One respondent- within each case- has a strategic position, in order gather information about the IMC and the motives for choosing that particular collaboration. The other respondent has a professional occupation in the procurement division, in order to gather information about how the collaboration regulates the market. With the interviews I have gathered information about perceptions of effectiveness.

3.2. Validity and reliability The restricted amount of cases and respondents in this research can harm external validity, because the results from these cases cannot be generalized to all other inter-municipal collaborations in the Netherlands (van Thiel, 2015, p. 62). Also, the results from the Public Body for instance cannot be generalized to all Public Bodies in the Netherlands.

In order improve reliability and validity I have used multiple aspects in order investigate the construct in our study; I have used literature, multiple laws, a report from CPB and the VNG in order to describe multiple options for cooperation.

Furthermore I have used the most recent and complete dataset of KWINK-group and PROOF-advisors to develop indicators that reflect structure characteristics. Regarding effectiveness in the Wmo, I have included two aspects, namely conditions for effectiveness and procurement instruments. Conditions for effectiveness are operationalised based on the most empirical findings, in which evaluation report of the CPB is the most important. Report from the CPB and the Public Procurement Research Centre are used for developing the indicators which reflect the procurement tools.

I used a semi-structured interview in this research, in which the questions reflect the indicators that are developed based on our theoretical discussion (see appendix II). This will to some extent lead to replicability (van Thiel, 2015, p. 120). Nevertheless, the questions are formulated in order accommodate the respondents’ capacity to elaborate on his perceptions of effectiveness. The interviews are also used to verify and to complement information that was gathered via document analysis; I have developed clear questions by limiting the length of the questions and by avoiding jargon and suggestive questions (van Thiel, 2015, p. 115).

I have recorded and transcribed all interviews in order to analyse and compare the results from the respondents. First, I have used codes which reflect a text fragment and used the respondents’ own words as much as possible. Next I have clustered these codes into categories. Finally, I have concentrated the codes into the concepts it represents (van Thiel, 2015, p. 172).

I will now discuss the results from the cases. I have investigated ROG plus which is a Joint Body with an executing Foundation, RGV which is a public body, the Social Domain Achterhoek which is a cooperation based on a Shared Vision and the Central Municipality Oss. But first I will elaborate on the Wmo.

4. Results I will start with an introduction about the Wmo and its objectives. Next I will use empirical results in order to clarify what is perceived as important aspects for implementing the Wmo. These aspects are translated into indicators in table 2 (page 22), which I referred to as ‘conditions for effectiveness’. These conditions are based on the law and the most recent empirical findings. Furthermore I will describe the results from all four cases.

4.1. Wmo As mentioned in the introduction, collaborations are moving from a transition phase- in which efforts were made for continuity of care and support- towards the transformation phase, in which collaborations are developing long-term quality plans (Gemeenten van de Toekomst, 2017).

Transformation is about a new way of thinking, in which self-reliance is emphasized. This means that local governments move towards a facilitating organisation. In order to achieve this, a new way of organising care is required. Transformation, then, is developing new approaches, innovation and investing in long-term solutions (Gemeenten van de Toekomst, 2017).

Self-reliance is perceived as a clients’ strength and responsibility and using the clients’ network to stimulate active participation in society. If there is no other possibility to stimulate self-reliance, than the municipality or IMC has to deliver appropriate support and care. Participation, then, is the result in the way someone is self-reliant (van der Ham, 2018, p. 10). Self-reliance, according to the law, is the capacity to perform the necessary general daily activities and performing a structured housekeeping (article 1.1.1, 1 Wmo 2015).

Customised services are important to improve public participation and self-reliance. According to the Central Bureau of Statistics (CBS) in the Netherlands, approximately 1 million citizens receive customised support, which is shown in figure 9. Domestic support includes personal care and day time activities. Services include home modifications, taxi services and services such as wheelchairs (CBS, 2017).

Customised services Wmo 800 700 600 500 400 701,835 300 200 408,665 100 264,76 34,995 0 Domestic Support Housekeeping Temporary care and Services Reception

Figure 9: Amount of different customised services

Collaborations measure self-reliance with the ‘self-reliant-matrix’ and client surveys. Not every IMC has proper monitoring instruments, nor is self-reliance or participation perfectly measurable. Some respondents in this evaluation also claim that this cannot be measured due to severe situations of some clients, who have multiple and severe problems and thus self-reliance and participation are not suitable objectives. Collaborations are still looking for appropriate monitoring instruments (van der Ham, 2018, p. 10).

In order to develop customised services, an integral approach is necessary, but this is sometimes obstructed due to competition between providers, bureaucracy and inflexible contracts (van der Ham, 2018, p. 14). Adjustment and cooperation among municipalities but also with insurance companies can be reached through investments in structural cooperation, information facilities and negotiation possibilities in order to integrate the laws (Programma Sociaal Domein).

Article 2.1.2, 4 Wmo, 2015 also dictates the need to have an integral service level, by including health insurers and healthcare providers, to focus on accessibility of services and to guarantee health continuity. Integral provisions also include the adjustment with other policy fields and the other pillars within the social domain if necessary (article 2.3.5, 5). Moreover, it is specified that plans have to include the preferred results, output indicators and criteria for healthcare-providers (6).

Although collaborations acknowledge the importance of integral policy making with the two other policy fields within the social domain, in practice, this is sometimes hard due to differences between the Participation Act and the Wmo. The Wmo is aimed at public participation; the Participation Act on employment. The Wmo provides entitlements and the Participation Act is more focussed on duties and supervision, which makes integral policy making within this domain hard. Nevertheless, the aim is to work together with the other pillars as much as possible (Panhuijzen, Verweij, van Houten, & van Xanten, 2017, p. 8).

Between the collaborating municipalities, the administrative systems are not well connected. Providers find it difficult to deal with multiple different rules, procedures and accountability mechanisms (van der Ham, 2018, p. 9). Administrative burden also negatively influences the accessibility of provisions for clients. Consequently, there is a strong need for standardising systems (VNG, 2018).

But quality also has to be measured and will consequently lead to more rules, registration and supervision. Collaborations want to find a balance between safeguarding qualities and limit administrative burden for providers to a minimum. Quality and other agreements are arranged in contracts. The scope of providers, funding methods and tendering models vary; each with their advantages and disadvantages. From the evaluation it has becomes clear that contracts with a one- year or two-year duration (60% in 2015) has led to insufficient investments in care and provisions (van der Ham, 2018, p. 50).

Finally, in article 2.1.3, 3, the local councils are obligated to make plans as to how to involve clients in developing policies and in article 2.5.1, the committee of mayor and aldermen have the task to investigate client satisfaction and the quality of social care. Moreover, article 2.6.7; the law also give the possibility for developing local initiatives. Finally, article 2.6.1. dictates that municipalities have to work together if that is required for an effective implementation of this law.

4.2. ROG plus ROG plus represents the municipalities Schiedam, Vlaardingen and Maassluis for implementing the Wmo. This IMC operates in the province of South-Holland. Initially, in 1994, the Foundation (ROG plus) was established to implement the Law Provisions Disabled (in Dutch: abbreviated as WVG). Since the decentralizations, the Wmo is included in this IMC (ROGplus, 2018).

4.2.1. Organisational structure The organisation includes a Joint Body, which consists of the aldermen of the participating municipalities who are responsible for the Wmo. This general management has installed an executive Foundation, which is called ROG plus. The director is appointed to manage the Foundation and is accountable to the general management. The latter remains politically responsible (Knol-van Leeuwen , Blase, Handstede , Lamers, Duijmaer van Twist, & Haan, 2017, p. 2). The scale in which the cooperation operates is approximately 185.000 inhabitants (ROGplus, 2018).

The Joint Body meets at least six times a year. This amount can be increased if at least two aldermen make this request. The Joint Body develops an annual report and budget and presents this to the participating councils and to the Provincial Executive. The Joint Body is also accountable to these institutions. Finally, information must be shared with the councils or individual councillors, if requested (Gemeente Maassluis, 2017, p. 3).

Table 3: Structure characteristics Foundation

Collaborative form Participating Jurisdictions Involved policy Participating governing bodies fields Municipalities

Joint Body Aldermen Policy Wmo 3 preparation Foundation Director Jointly Executing Tasks

According to the respondent, connections are made between the IMC and the municipalities with account managers. ROG plus, as well as every municipality, have an account manager. The account manager structures relevant information, adjusts policies between these actors and translates this into recommendations for the Local Enactment Wmo.

Furthermore, the respondent mentioned the ‘district-teams’, which were established in 2014, and are responsible for tasks in the field of prevention, conducting health-assessments for Youth-law and keeping contact with clients and schools in the districts. These teams are organised in different ways. One team is based on a public-private partnership, another team is formed by civil servants and employees from one healthcare provider and another team is formed by multiple providers, based on secondments.

4.2.2. Tasks and jurisdictions ROG plus has developed a strategic plan with short-term and long-term goals. The Foundation is authorized concerning homecare assessment, procurement of healthcare provisions, contract management and Wmo customized provisions. Currently the scope is extended with domestic support, organising day-time activities, individual support, protective sheltering, development of an ICT-system for district-teams and back-office activities (van Aaken, 2017, pp. 5-6).

In order to successfully coordinate these tasks, ROG plus conducts legitimacy tests and quality inspections for the purpose of financial manageability and expediency (van Aaken, 2017, p. 11).

PGB-teams1 inform clients about the budget provisions and check its expediency and justifiability (van Aaken, 2017, p. 14). Regarding information management, Business Intelligence Tools are used and (statistical) information from the knowledge Centre MVS (van Aaken, 2017, p. 15). To optimize the quality of contract management, quality investigations are conducted, which contributes the Foundations’ role as a policy advisor. Quality is guaranteed through document analysis and through surveys among clients. ROG plus has established an online platform for this purpose (van Aaken, 2017, p. 16).

The mid-term objectives of ROG plus are to increase an integral approach concerning the Wmo and Youth-law. Reason for this is to prevent that youngsters are not suddenly excluded from support when they reach the age of 18. Another objective concerns the Foundations’ policy advising role; information is gathered with notices of objections, jurisprudence and feedback from clients and stakeholders. Therefore the Foundation wants to develop topic meetings in which specific topics will be discussed for optimizing their advising role (van Aaken, 2017, p. 18).

4.2.3. Motives for collaborative form According to the respondents, the reason for choosing an executive Foundation is the separation of politics and the implementation of the Wmo. Moreover, a Foundation may not have a profit- objective, which is more prominently propagated with this choice. Also, a Foundation can have its own employment policy and, to a larger extent, the respondents mention the advantages of having legal personality. The respondent argues that the separation between implementation and politics is more effective. A private entity does not have to adjust its processes to the participating municipalities, as opposed to cooperation in the region for the Participation Act.

One respondent argues that one of the advantages of an independent employment policy is diversity: in content and in culture. Personnel flow in the workforce is a great development according to the respondent. Employees have backgrounds from multiple different organizations in the private sector and therefore the perceptions towards processes or problems are also different. In a cultural sense, the respondent mentions added value of some employees who have a more commercial and proactive attitude. The respondent argues that this should be translated into practice by developing a strong profile as a centre of expertise for the region, and by more proactively informing organisations. The latter is developed by organising knowledge-meetings between consultants, providers and the cooperation.

4.2.4. Accumulating knowledge and expertise ROG plus is moved towards the transformation phase. In the transition phase they have learned that health assessment is a very specific task and they are lobbying to convince municipalities about this learning experience. ROG plus wants to profile itself as a knowledge- and expertise centre in the field of health assessment in the region. This includes the assessment as to what extent a client is entitled to a certain degree of provisions and support. They want to distinguish themselves and gain the right to exists from this expertise (van Aaken, 2017, pp. 12-13).

1 PGB is an (personalised) budget, which means that a client can get a budget to buy customized healthcare services, household-support or other provisions.

There is a greater need to frame tasks and responsibilities. Different tasks have never been separated and framed properly. Municipalities can change this, by taking an active coordinative role according to the respondents. They give the example of health assessment: ROG plus is competent regarding delegation, but the district-teams are competent regarding the mandate. Delegation gives the right to grant a permit (which gives a client the right for certain provisions and support) and the mandate assesses the needs of a client. A pilot has been launched to improve cooperation between the Foundation and the district-teams.

4.2.5. Client and citizens’ involvement Citizens and clients have the opportunity to influence rules and decision making. Examples are citizen councils and public participation meetings with municipalities. ROG plus has initiated a platform, in which citizens can influence policy making, but they also have meetings with a selected group of clients and also conduct surveys (van Aaken, 2017, p. 16). Input can be tested in practice, according to the respondents and consequently can have impact for the whole region, after proven success. Objections and complaints are separately organised, but the cooperation has the right to process objections and appeals.

4.2.6. Integral policy making The respondent gives an example of a current innovation; the ‘one package of services’, in which different provisions and support are combined in one customized package. Providers, therefore, do not have to visit the same client multiple times a day, but only one time. Also the clients are better served. Moreover, ROG plus tries to get different groups with the same provider in order to realise the same provisions for the entire region.

Integral policy making with the Youth Law is still difficult due to the separation of tasks and working methods. A better separation of tasks, but also intensifying cooperation with the district teams should improve integral policy making (van Aaken, 2017, p. 11).

Furthermore, adjustment is reached by working together with another IMC in the region regarding the Participation Act. Therefore adjustment is realised by supporting people from ‘day-time activities’ towards actual employment.

Nevertheless, respondents find the usage of terms in the social domain ambiguous: in the Participation Act, ‘day-time activities’ for example has another meaning than in the Wmo. Uniform concepts can have an effective impact on integral policy making. Respondents mention that the laws in the social domain do not provide this yet.

4.2.7. Effectiveness Effectiveness is reached with a relatively equal implementation of the Wmo is the region, according to the respondents. Therefore ROG plus wants to intensify the relationship with the district-teams. The respondent argues that this makes it hard for the cooperation to reach its effectiveness on the one hand, and at the same time satisfy the needs of the municipalities. Also the different structures of the teams make it hard to implement a joint policy.

Respondents mention that a scale of 185.000 inhabitants is effective, because suppliers benefit from a bigger market. This scale also functions as a counterforce against the larger region of Rotterdam, which geographically encloses the region. They secure continuity of healthcare by a fixed term of five years for the participating municipalities to stay in the cooperation; if they (partially) want to have an opt-out they still have to pay their share to the cooperation (Gemeente Maassluis, 2017, p. 4).

4.2.8. Procurement and contract management Most provisions are obligated for public tender, due to the fact that ROG plus has to purchase a lot of wheelchairs, escalators and taxi services for the region, the respondent claims. The number of registrations for the public tender commonly varies between 2 and 4. In the past there was a lot of price competition which affected the quality of services and provisions. The respondent claims that this has led to impoverishment of certain niche-markets, in which only some investment companies remained in the market. ROG plus has moved towards more quality, which was also stimulated by the national government, who has introduced minimum prices.

For contracts, the so called ‘Zeeuws model’ is used, but the respondent tends to advise an ‘Open House’ model during registration. This means that more providers can register themselves and consequently clients have more freedom of choice. The administrative burden will be increased due to the fact that more providers can register and thus the financial- and production accountabilities will increase correspondingly. Besides the funding method P x Q, a budget based on results is also used, according to the respondent. This is based on a point system, in which a point represents a certain budget. The respondent claims that this is ineffective and inefficient. Therefore, they want to harmonise objectives with providers.

The respondent prefers long-time relationships with providers in order to stimulate the necessary investment in quality. The average duration of a contract is 4 years. Long-term relations also stimulate convergence of objectives. Therefore the option for contract extension is almost always used, the respondent claims. “The pool of potential fish is limited but qualitative robust”, the respondent concludes. In order to secure this, investigations are conducted for quality and client satisfaction. Moreover a supervisor is available to investigate incidents. Also dossiers are screened and tested in practice on promised output. Most providers are relatively big and the Foundation does not use sole proprietorship, due to the condition that every company needs to have a client- representation.

Finally, the clients’ freedom of choice is rather limited: the client can choose from the 31 contractors or for a personalised budget (PGB). The respondent mentions that ROG plus is not really transparent about providers. On the other hand, they also think that clients do not necessarily want to choose. Clients just want to be informed properly. Trust and personal contact are far more important than the freedom of choice, according to the respondents.

4.3. Region Gooi and Vechtstreek The Region Gooi- and Vechtstreek (hereafter: RGV) is an executing Public Body in the province of North-Holland. RGV represents the municipalities Blaricum, Eemnes, Gooise Meren, Hilversum, Huizen, Laren, Weesp and Wijdemeren. I will now elaborate on the organisational structure of RGV (Regio Gooi-en Vechtstreek).

4.3.1. Organisational structure RGV constitutes a cooperation between eight municipalities. The scale is approximately 250.000 inhabitants (Bakker & Broertjes, Programmabegroting 2018-2021, 2017, p. 4). The relation between the cooperation and the municipalities is based on the principle of ‘client’ and ‘contractor’ in which the RGV takes the role of contractor in relation to the participating municipalities.

Table 4: Structure characteristics Public Body

Collaborative Participating Jurisdictions Involved policy Participating form governing bodies fields municipalities Public Body Mayors and Determine Physical 8 Aldermen policies Councillors Executing Education primary tasks Civil service Supporting tasks Energy and sustainability Culture Economics Recreation Youth-Law Wmo Safety and Public Health Transportation Refugee Centre

In 1967 the Public Body was initially established to answer the strong need for housing. Because the Public Body was effective in her housing policy, there was a spill-over effect to other affiliated fields and so, since 2015 the decentralized tasks of the social domain were also included. Besides the increase in the amount of policy fields, also more municipalities were included in the Public Body, the respondent claims.

The respondent argues that experience created trust among the participating municipalities. Due to trust, but also due to ‘visionary governors’ and ‘smart civil servants’, the transition phase progressed successfully. Relevant models and financing- in order to shape the decentralisations- were initiated swiftly and embedded in the proper level of the Public Body, the respondent claims. This has also had a positive impact on trust, which is illustrated in the following paraphrased fragment:

“In multiple levels of the organisation, and also between multiple municipalities, there is discussion and consensus-building, in which different aspects lead to one vision. This secures stability: participating municipalities trust the RGV. When something goes wrong or the financial pressure increases, than there is no sudden changes in the models or systems that are being used, which is sometimes the case in other municipalities”.

The respondent mentioned the danger of sudden changes with the following quote:

“If you squeeze a pile of sand real hard, most of it will slip through your fingers.”

Currently, the general management only includes mayors from the participating municipalities. This leads to more focus on business management issues, and less on the content of policy making. Therefore, the RGV will change this into an aldermen model, in which business management and policy making are combined and leads to more integral policies. The reason for this is that aldermen are politically responsible for the social domain. If they also have the role in coordinating business- management, then integral policy making is secured and expenses are made efficiently and effectively, the respondent claims.

Respondents think the political model- in which representative councillors from the municipalities participate- is not preferable. The reason for this is the pressure of local and electoral considerations, which can endanger the role a councillor should have in the RGV, namely to serve the interest of the region and not the interests of one municipality and/or political party.

The respondents’ perception of the role of municipalities is mainly the distribution of scarce resources and to guarantee quality. Therefore the relation between municipalities and the RGV is based on contractor and client. The councils develop regional priorities and corresponding financial frameworks in which the aldermen can develop specific executing programmes. These programmes, in turn, are transmitted back to the councils, in which adjustment can be made. Other instruments of the councils are the annual planning- and control cycle.

Another financial instrument is applicable in the case of an (partial) opt-out. Although the municipalities are free to implement their own policies; deviating from joint developed policies leads to a partial opt-out and consequently, leads to a financial burden (Gemeente Gooische Meren, 2018, p. 11). Opt-outs are sometimes seduces through regional frictions, which can be caused by practical or political considerations. An example is the possible merger of one participating municipality with Amsterdam. These financial compensations for opt-out, though, are a very effective instrument according to the respondent.

4.3.2. Tasks and objectives The RGV is competent to manage contracts and check on legality of expenses that have been made. This also applies to customized services regarding Youth-Law. Moreover, the RGV has also taken the role of Central Municipality for the tasks regarding Assisted Living and Social Care (Bakker & Broertjes, Programmabegroting 2018-2021, 2017, p. 12).

The division of procurement- and contract management is responsible for purchasing individual provisions within the social domain and monitors the goals that were set in the contracts. Besides these primary tasks, the goals within this division are also to seek connections with the physical domain. The procurement- and contract management division is responsible for managing and

32 implementing procurement-trajectories for multiple clients. Moreover, they support clients with their questions and develop and improve cooperative relations and also want to become a knowledge- and expertise centre (Bakker & Broertjes, 2017, pp. 12-14).

4.3.3. Motives for collaborative form The reason for choosing a Public Body, according to the respondent, is due to an equal balance of forces between the participating municipalities. It is necessary to take topics out of local politics, in order to guarantee integral policy making in the social domain, the respondent argues. A corresponding scale is then required. RGV serves about 250.000 inhabitants, which is a comparable scale with other relevant organizations, like insurance companies, the UWV (institute for employment insurances) and housing associations. Consequently, scale makes it possible to operate as an equal partner with other relevant organizations in the region and makes it possible to have an integral approach on the different tasks in the social domain, the respondent claims.

4.3.4. Accumulating knowledge and expertise Knowledge and expertise accumulates via recruiting the smartest boys and girls from the participating municipalities, as the respondent refers to the employees in the RGV. The RGV offers a higher salary than municipalities and gives the opportunity to become a specialist in one of the collaborations’ divisions. Another way of getting information and expertise is by attracting ‘know how’ from the market and also through external expertise.

4.3.5. Client- and citizen involvement According to the respondent, employees work four days a week in the municipalities and local districts and have contact with clients and citizens. One day a week, employees work in the RGV and share this information. Information is also deduced from complaints. Although the RGV does not decide on medical complaints, it can take the role as mediator between client and provider. If conditions in the contract are not satisfied, the RGV can demand compliance.

4.3.6. Integral policy-making The committees of mayors and aldermen from the participating municipalities can install ‘portfolio- meetings’, which are formed by relevant aldermen who are responsible for the Wmo. In these portfolio meetings, joint objectives are coordinated and adjusted between the participating municipalities. For this purpose, an all-encompassing ‘regional cooperation agenda’ is established with corresponding (financial) priorities (Gemeente Gooische Meren, 2018, pp. 7-8). An example of integral policy making is between housing and the social domain. Ten different groups require specific housing needs and this has to be built accordingly.

4.3.7. Effectiveness RGV is effective because it combines procurement work with inspection tasks. Moreover, providers only have to deal with one contract manager, instead of 7. Furthermore, RGV provides an innovation budget for providers to test a new intervention or methods. After proven effectiveness, this innovation will be shared with the market for further exploitation. The providers will be paid for his innovation and therefore there is an incentive for continues innovation. The respondent mentions that effectiveness is evaluated by dialogue with providers through the entire process and with knowledge-sharing in the triangle (clients, providers and RGV). The power of the market will be the power of creativity; continuously seeking dialogue is also needed in order to take the proper role as a facilitating government, the respondent claims.

4.3.8. Procurement and contract management Budgets for contracts are developed based on the required clients’ needs of care and support. Consequently a client is classified and a corresponding time frame and budget is set up. The respondent argues that suppliers are free in how they spent the budget, because the assumption is that suppliers know best as to how to allocate care and provisions and thus spent the budget.

The funding method that is used is P x Q. The method of contract management is an open house method, namely ‘dynamic contracting and management’. Within this method a minimum of quality standards are guaranteed. Also a clients’ freedom of choice is an important feature in this method. Moreover, providers can register themselves through the entire process, which makes it possible for clients to switch from provider. This is an incentive for providers to also include additional quality (van der Spek-Stikkelorum , 2018). This can be subjective and thus causality cannot be measured between intervention and results and therefore cannot be stipulated in contracts. Client satisfaction though can give some input, the respondent argues.

The respondent argues that tender lead to quantitative competition, which leads to lower prices and lower quality. The respondent argues that when quality is high, the price automatically will turn low, due to faster achievements of objectives. Funding is based on function and on actual effort. The respondent also nuances his perception. Providers want to provide services and always see additional work that needs to be done to increase quality. Also, the respondent argues that a clients’ choice for a certain provider is based on comparison, but this is not always based on solid considerations, due to an information deficit.

The respondent nuances the concept of freedom of choice: although it can open up new possibilities like increasing independence and responsibility, in practice freedom of choice is not always used. Some clients cannot choose. RGV, then, forces people to choose. Although this sounds like a paradox, RGV does not see themselves as an organisation that has to choose for clients; their role is to inform people about the best possible options that fit their needs, the respondent claims.

Furthermore the respondent states that informing clients can be proactive, as well as reactive: if people systematically have complaints about the same provider, than this will be answered with the remark that they have an option to choose another provider.

Citizens (clients), RGV and providers are in a triangle, the respondent claims. Access to providers and freedom of choice is depending on customization, amount of providers and the results that need to be achieved. Thus, the reason for choosing dynamic contracting and management. Tender is a bilateral relationship between municipalities and providers, while the client is the most important actor in the triangle. This approach leads to customization, because rules and conditions can be changed for the purpose of customization. Changes are not made unilaterally, but are discussed first in the triangle, according to the respondent.

The respondent mentions that the average duration of a contract is 4 years. If a contract is longer than 4 years, it needs to be motivated and other providers must have the chance to make an appeal. Tender is only used if the market can only deliver a few providers or when procurement is not efficient with more than a few providers (such as taxi services).

4.4. Social Domain Achterhoek In the region Achterhoek (Province of Gelderland), the municipalities Berkelland, Montferland, Aalten, Oude Ijsselstreek, Winterswijk, Oost Gelre, Bronckhorst and Doetinchem are cooperating in the social domain. I will now elaborate on the organisational structure of this IMC.

4.4.1. Organisational structure This is a cooperation between 8 municipalities. These municipalities only collaborate based on a common regional vision. The regional vision is developed by establishing a framework, which is elaborated in four sessions with civil servants, aldermen, representatives of citizens and healthcare providers (Sociaal Domein Achterhoek, 2017, p. 2). The vision only concerns the Wmo and Youth-law for now. After having developed an effective approach, the vision can be expanded to other policy fields like the participation act (Sociaal Domein Achterhoek, 2017, p. 3).

Table 5: Structure characteristics

Collaborative Participating Jurisdictions Involved Participating form governing bodies policy fields municipalities Network model Aldermen No formal Wmo 8 Shared Vision jurisdictions Civil service Youth-Law

The municipalities together have a coordinative role within the region. Although municipalities are cooperating on a joint procurement plan, municipalities still have one contract manager and every municipality has its own procurement plan for domestic support. The other requirements for procurement in the field of Wmo and Youth-law are jointly executed by the division CLM on a regional scale on behalf of all eight municipalities (Sociaal Domein Achterhoek, 2017, pp. 11-12).

Nevertheless, local implementation is based on the regional vision and implementation is also monitored on a regional scale. Customization, experimentation and coordination are leading principles for a bottom-up approach in which different local approaches can learn from each other (Sociaal Domein Achterhoek, 2017, p. 10).

4.4.2. Tasks and objectives The municipalities are responsible for developing a long-term strategy and the committees of aldermen specify the objectives, outcomes and topics for cooperation. The Management Meeting Social Domain (MOSD) is responsible for the allocation of resources and staff and also for an integral approach and a coordinated and adjusted implementation of the objectives that need to be implemented. POHO include the responsible alderman for a particular topic within the Social Domain (like Wmo or Youth-Law), and the management directors are responsible of adjusting its activities to the committee of aldermen. The meetings are with officials and seek adjustment with the project teams. The project teams in turn also adjust their activities with the contract- and supply management team. The latter is the only official executing body within this cooperation (Sociaal Domein Achterhoek, 2017, pp. 20-21).

4.4.3. Motives for cooperation The reason for choosing this type of cooperation is to protect local interests and local needs, according to the respondent. Cooperation based on the WGR makes it possible that one municipality can be outvoted by the other municipalities, which can harm local interest and local needs. The current informal way of collaborating gives the possibility to develop policies among a ‘coalition of the willing’. Both respondents claim that the political differences are too strong for transferring competences and jurisdictions to a new regional organisation. One respondent claims that this is only based on sentiments and not necessarily by its content. The other respondent claims that the political objectives differ between the participating municipalities.

4.4.4. Accumulating knowledge and expertise Respondents claim that knowledge and expertise are accumulated in the project groups, where policies are being prepared. The project groups also have an advising role towards the MOSD. Also, the consultants who are responsible for the entrance of care and support have the proper knowledge and expertise because most consultants have a background in especially Child Protective Services. Moreover, on different levels in the cooperation, policy is developed, discussed and adjusted. The respondent state that the amount of meetings will be reduced, because it turned out that the status quo was ineffective. The respondents argue that one time each month should be sufficient instead of two times. Finally, the respondent argues that the competence to grant a permit- which gives somebody certain rights for care or support- should be strictly separated from the actual services that need to be provided.

4.4.5. Client- and citizen’s involvement Representatives of citizens have participated in the development of the shared strategy (Sociaal Domein Achterhoek, 2017, p. 2). Currently, citizens can influence policies in their own municipality. There are no specific meetings facilitated in the cooperation. Furthermore freedom of choice is guaranteed for clients with a large supply of providers.

4.4.6. Integral policy-making The regional vision is especially aimed at prevention. Prevention is obtained through an integral approach, which means that other policy fields- like, employment, sports, education and culture- but also cooperation with civil society organisations are included. This cooperation has categorised prevention in four domains: universal, selective, indicated and prevention based on treatment. The cooperation develops multi-annual programmes in order to specify these dimensions and make them measureable. An annual implementation plan is developed as well (Sociaal Domein Achterhoek, 2017, p. 8). Cooperation is based on a shared sense of responsibility, in which there is the possibility for developing new approaches and methods within each municipality. Budgets are integrated for that purpose (Sociaal Domein Achterhoek, 2017, p. 12).

With regard to innovation, this cooperation has based themselves on two approaches. The first one is based on an approach in a municipality in Denmark, which is also referred to as the Esbjerg-model. This model is aimed at rehabilitation with a holistic approach: coordination is sought between professional, client and his network. This coordination leads to a specified and scientific intervention. Another approach is from Machteld Huber’s ‘Positive Health’, which constitutes a broad view on health, which is aimed at individual empowerment. Multiple action perspectives are suggested, based on multiple dimensions. These dimensions include body-functions, mental wellbeing, essentialism, quality of life and daily functioning (Sociaal Domein Achterhoek, 2017, p. 8).

4.4.7. Effectiveness This informal cooperation has a lot of complex negotiation structures, which sometimes makes it ineffective, according to the respondents. This has been changed by reducing the frequency of meetings and by specifying roles and responsibilities. According to the respondent, cooperation based on a ‘coalition of the willing’ gives the opportunity to test multiple approaches in the same region and learn from each other’s best practices. Furthermore, the respondent argues that with a coalition of the willing, municipalities can satisfy and guarantee local interests.

4.4.8. Procurement Management Tools The respondents state that the MOSD is the informal client of the procurement division. The aldermen from the participating municipalities have made a decision to organise this, but there is no formal mandate that authorizes the MOSD as a formal client.

The cooperation uses an open house methodology, which means that every provider can write a proposition at any time, but there are only four moments for assessment each year. Also, individual agreements and contracts are closed with providers. The respondent mentions that the cooperation prefers official tender, because this makes it possible for providers to work in every municipality in the region.

The average contract duration varies with every specific task. However, the minimum duration is at least one year, the respondent claims. Domestic help for instance has an average contract duration of two or three years, as well as for certified institutions for people with more complex problems.

There are approximately 400 or 500 providers according to the respondent and the funding method is P x Q. The respondent argues that this method is used to guarantee some stability. This funding method was also used in the previous law, namely the AWBZ. Although they are still using this funding method, the respondent mentions that they want to switch towards a budget that is based on results. The respondent acknowledges the advantages and disadvantages of both funding methods, namely overproduction with P x Q and dissatisfaction about the limited possibilities of a budget based on results.

Although the cooperation currently emphasizes quality, the respondent claims that the quality standards can also lead to administrative burden. Especially small providers can experience this, because they have to provide support and care and also have to do their own administration.

The contract management team is also responsible for monitoring results and to check on potential fraud. The respondent mentions that there are not many monitoring instruments. The main instrument is using surveys with clients. Another instrument is the self-reliant matrix in order to monitor results.

The respondent claims that especially with the personalised budgets, the risk of fraud is severe. One measurement to combat fraud is the demand of a budget plan for whoever receives a personalised budget. Besides the monitoring task of the procurements division, the Social Insurance Bank also monitors potential fraud with personalised budgets. Nevertheless, if a client and provider make a deal about the budget, than it is really hard to detect fraud, according to the respondent. Finally, the procurement division also collaborates with the GGD (Municipal Health Agency) which is competent to start investigations.

4.5. Central Municipality Brabant North-East The Central Municipality constitutes a cooperation between 10 municipalities in Brabant, namely: Oss, Mill and Sint Hubert, Grave, Sint-Anthonis, Bernheze, Boekel, Boxmeer, Uden, Cuijck and Landerd, article 1 (Boxmeer, 2016). Because the municipality of Oss is the Central Municipality I will refer to the IMC with Oss.

4.5.1. Organisational structure The 10 participating municipalities have transferred the tasks and corresponding competences to the Central Municipality for executing the tasks in the Wmo and thus Oss is mandated by the other ‘host municipalities’ in order to implement the Wmo, according to article 3 (Boxmeer, 2016).

There are two formal negotiation structures between the host-municipalities and Oss. The aldermen from all municipalities who are responsible for the Wmo meet in a governing meeting, article 10 (Boxmeer, 2016). Also the host-municipalities are separated in three regions, in which one official for each region is designated as a representative and participates in an official consultation. This representative has an intermediary role between the municipalities in the region and Oss, article 11 (Boxmeer, 2016).

Oss is entitled to have every information from the host-municipalities in order to execute the tasks within the Wmo properly. The aldermen have an intermediary role between Oss and the host- municipalities for sharing information, according to article 12 and 13 (Boxmeer, 2016).

There are two policy cycles: three meetings are between the aldermen in which objectives are determined for the coming year and accountability takes place. The other cycle is between the officials, in which the realisation of these objectives is negotiated, article 26 (Boxmeer, 2016).

Table 6: Structure characteristics Central Municipality

Collaborative Participating Jurisdictions Involved Participating form governing bodies policy fields municipalities Central Aldermen Joint procurement Wmo 10 Municipality policy Civil service Policy development Legal supervision

4.5.2. Tasks and objectives Oss has the jurisdiction to implement procurement policies. Policies are jointly prepared and developed in the region with project groups, in which civil servants from the region participate. Household care has been added to the negotiation table, which means that four different negotiation structures are now clustered into one (Wmo BNO-O , 2017, p. 9). Oss also executes the tasks regarding supervision- which relates to incidents and calamities-but also on signals for quality improvement. Jurisdictions regarding supervision on personalised budgets remain with the municipalities, but adjustment is sought with Oss (Wmo BNO-O , 2017, p. 10).

4.5.3. Motives for cooperation The reason for collaborating in a Central Municipality was the need to collaborate in a relative mild form, in which responsibilities and a mandate could be settled, but also a cooperation which is flexible and in which things can be intermediately adjusted, the respondent argues. Another reason is the cooperation with another IMC in the region who implement the Youth-Law, which is a Central Municipality as well.

4.5.4. Accumulating knowledge and expertise An integral approach is aimed at preventing clients from claiming specialised care. This is achieved through exchanging knowledge regarding mental healthcare problems (GGZ), accumulating knowledge by intensifying cooperation with district teams and general practitioners and by informing clients and citizens about specialised aid (Wmo BNO-O , 2017, p. 11).

The information systems Synaxion, GWS and SVB are clustered into one system and the structure is adapted in order make the system more convenient for municipalities. Also qualitative data is gathered by starting with conducting the legal obligated client surveys.

An overview of providers in the region is made transparent in a ‘digital geographic map’. Finally all providers are connected to ‘I-Wmo’, in which a uniform way of messaging- like expenses and new innovative products- are settled (Wmo BNO-O , 2017, p. 14).

4.5.5. Client- and citizen involvement Only general measurements apply for citizens and clients who want to influence policy. Big companies are obligated to have a client representation in their organisation and Oss uses client surveys, according to the respondent. There is no specific information about options to participate in policy development.

4.5.6. Integral policy-making There is no formal connections between the IMC who implements the Youth-Law or with the Participation Act. On case-level, though, adjustment is reached with especially Youth-Law, according to the respondent. The respondent also argues that they do not want an integration of the different pillars of the social domain, because they are satisfied about the functioning of their cooperation in the Wmo. The Youth-law is too complex and therefore they only want to seek adjustment in specific cases and not in a formal, structural way.

In the field of procurement there is little adjustment between the different policy fields in the social domain, and therefore services are provided separately. There are some project groups to discuss integral products, but this has only recently been initiated, according to the respondent.

Innovation is facilitated by organising a meeting between 36 providers and Oss, which has led to 7 themes which are elaborated in project plans (Wmo BNO-O , 2017, p. 6). Moreover, 9 quality dimensions are developed which all providers must live up to (Wmo BNO-O , 2017, pp. 6-7). Oss connects with providers’ quality systems and quality marks. If a provider does not use a certain quality system, than a quality system will be established based on adjustment between the provider and a contract manager (Wmo BNO-O , 2017, p. 7). Another quality dimension is to support providers in developing a budget plan in which budget goals must be formulated in a very specific way and it has to be substantiated how a provider will achieve those goals, the respondent argues.

4.5.7. Effectiveness The respondent claims that the Central Municipality is effective because tasks are properly shared. In meetings between aldermen and in the project groups, policies are jointly prepared. Oss does not act on its own, although they are mandated to do so. Another aspect which improves effectiveness, according to the respondent, is the limited amount of negotiation structures, in which providers, clients, municipalities and Oss negotiate about quality standards.

4.5.8. Procurement Management Tools Adjustment between Oss and providers is facilitated with negotiation meetings, which has resulted in a better understanding of cost structures and care volumes, which is necessary in order to improve the procurement policy (Wmo BNO-O , 2017, p. 4).

The model that is used for procurement is administrative tender. The reason for this, according to the respondent, is because in 2014- when the cooperation was established- municipalities did not know much about care, support and other provisions. With this model, which was also used during the previous law, the cooperation wanted to use the knowhow of the market by opening up a dialogue with providers.

Oss coped with fragmentation, administrative burdens and negative effects on quality. Therefore Oss wanted to introduce two moments for registration in order to decrease the administrative burden. Moreover, they want to conduct critical negotiations with providers who did not have had any clients in two years (Wmo BNO-O , 2017, p. 5). Currently Oss has closed 200 contracts with providers. Approximately 10 providers have 80% of the market, according to the respondent.

Oss wants to differentiate in living arrangements, with corresponding specific fixed prices. In order to make a substantiated decision, Oss want to hire external expertise and start a benchmark in order analyse which prices and living arrangements are organised in other regions. Furthermore, providers do not have an incentive to decrease the care volume, which results in waiting lists. For this reason a pilot has been launched to initiate intermediate forms which is referred to as ‘living with support’ (Wmo BNO-O , 2017, p. 8).

The respondent states that quality is guaranteed by stipulating quality standards in agreements. Providers must sign this in order to get a sub-agreement. Providers have to hand in information that proves that they meet these standards. Examples of these quality standards are the level of education, certificates and the condition that providers with a certain size include a client representation in their organisation.

The funding method for protective sheltering is P x Q. For other products, an average price is determined in which a provider has to deliver the necessary care and support. According to the respondent, this will prevent overproduction. The client and provider negotiate about the support, in which the clients’ freedom of choice is an important factor to regulate the market.

Client-surveys are also used as a monitoring instrument, but with this instrument, certain flaws or hazards cannot be traced back to individual providers. Another instrument is evaluation meetings with providers. The respondent admits that there are problems with the separation of assessment and referencing providers for certain care and support. The entrance of care is performed by consultants, but sometimes providers’ employees also join the initial meetings when a client’ needs are assessed. This is of course prohibited due to mixed interest, the respondent argues.

5. Analysis In order to make clear comparisons between the different inter-municipal collaborations; I will refer to the different collaborative forms instead of the name of the particular IMC. First I will elaborate on the cooperation characteristics, which are presented in table 7. Next, I will discuss the conditions for effectiveness and finally will elaborate on the procurement instruments.

5.1. Cooperation characteristics

IMC ROG plus RGV Social Domain Oss Achterhoek Collaborative Foundation/Joint Public Body Shared Vision Central form Body Municipality

Administrative Integration model Integration model Network model Integration model form

Number of 3 8 8 10 participating municipalities

Scale 185.000 250.000 300.000 275.000

Participating Aldermen Mayors and Aldermen Aldermen governing Director Aldermen Civil servants Civil servants bodies Councillors Civil servants Tasks and Policy preparation Policy preparation No formal Tasks, including jurisdictions Jointly Executing and development. jurisdictions. procurement. Tasks, including Supporting tasks. Joint Policy preparation. procurement. Jointly Executing procurement Executing primary Executing primary Tasks, including policy tasks. tasks. procurement. Executing primary tasks. Involved policy Wmo Wmo Wmo Wmo fields Youth-Law Youth-Law Physical Motives for Separation of local Separation of local Developing This form is collaborative politics and politics and effective policies flexible, but can form implementation implementation based on a also arrange practices. practices. ‘coalition of the mandates and No profit objective. Experience, trust willing’. responsibilities. Benefits of legal and consensus- Protecting local personality. building. interests.

Table 7: Overview Cooperation Characteristics

Although respondents from the Public Body and the Foundation argued that it is more effective to separate the implementation of the Wmo from local politics, literature states that this also leads to a democratic deficit and an increase of new complex negotiation structures; especially in large collaborations (Uenk, 2017, p. 15).

On the contrary, the respondent from the network model chose their Shared Vision in order to protect local interests. This was needed because there were differences in ambitions about policy development in the Wmo between the municipalities, but also due to local sentiments. The biggest fear was to be outvoted in decision making, which can be the case in a formal cooperation, like the options the WGR provide. On this level, the Shared Vision is effective due to a same sense of urgency and a common vision about goals and levels of quality (Schep, 2010, p. 14).

Another feature is scale. All respondents claim that effectiveness is reached due to a larger scale compared to a situation in which every single municipality has to implement the Wmo on its own. This is due to a bigger market which is attractive for providers, stimulates competition and consequently leads to more choice for collaborations and clients. Moreover, with one procurement division it is also more effective compared to a situation in which every municipality has its own procurement division and correspondingly other funding methods, contract models and product codes (Uenk, 2017, p. 15).

Cooperation also leads to a relative equal supply of care, support and provisions in the region, respondents claim. One respondent from the Public Body argues that inter-municipal cooperation becomes effective with a scale of approximately 80.000-100.000 inhabitants. But when the access to care is differently organised- which is the case in the Foundation, the Central Municipality and the Shared Vision- than this can block effectiveness. For this reason an integral service level is obligated in order guarantee access to health and health continuity according to article 2.1.2. Wmo.

Finally, dialogue, consensus-building and adjustment leads to effectiveness according to the respondent of the Public Body, in which on all levels in the organisation adjustment and negotiation takes place. This is also the case in the network model (shared vision). On this level the Public Body and the Shared Vision are effective on the level of communication which increases trust (Schep, 2010, pp. 38-39).

Nevertheless a lot of negotiation structures have been developed, but this turned out to be ineffective. Consequently, the Shared Vision has increased the responsibilities of some committees. But this also turned out to be ineffective, which resulted in a reduced frequency of negotiations. Now, municipalities collaborate based on a ‘coalition of the willing’, which corresponds with the polycentric view of respecting local autonomy in which each municipality can freely enter a cooperation in which the institutional design depends on local specific issues (Klok , Denters , Boogers, & Sanders, 2018, pp. 527-528). This has an effective impulse on experimenting with different methodologies in multiple municipalities in the region which leads to new insights and this knowledge is shared in the region.

The Central Municipality argues that it is effective when the amount of negotiation structures is limited to three, and when tasks and responsibilities are properly distributed and when there is a balance to coordinate responsibilities, but also to guarantee some flexibility. This has a positive effect on limiting the transaction costs (Klok , Denters , Boogers, & Sanders, 2018, p. 529).

5.2. Conditions for effectiveness Effectiveness is assessed in the way an IMC is able to create added value to the community (Provan & Milward, 2001, pp. 416-417), is able to provide basic- as well as additional services (Provan & Milward, 2001, p. 418) and the IMC is able to extract and distribute resources (Provan & Milward, 2001, p. 419). Providing an integral service level is also dictated by the law according to article 2.1.2 and 2.3.5 Wmo 2015.

On this level the Public Body is effective because it has the most involved policy fields in order to implement integral policies. These policy fields are already executed by the Public Body and can be adjusted via portfolio meetings between the relevant aldermen. Furthermore, only the Public Body is competent to actually develop policies; opposed to the other collaborations that are only competent to prepare and to implement policies.

The second most policy fields are included in the cooperation which is based on a Shared Vision. It depends on a client which policy fields have to be involved. Customised services are predominantly aimed at prevention. The Central Municipality has the least developed integral policies; they only develop integral policies on case-level. I cannot state that this is effective or ineffective; I can only conclude that the focus is on the Wmo and that there is no ambition to intensify the cooperation with the other policy fields.

The Foundation collaborates on case-level with the participation act in the region. Main reason for collaborating is to help people who are entitled to ‘day-time activities’ towards actual employment. Integral policy making is limited, though efforts are being made to intensify cooperation with the district teams and with Youth Law. Therefore they are only effective in providing basic services and to added value which is limited to the Wmo.

Expertise and specialisation lead to cost savings regarding policy development, monitoring and controlling and reduces the need to hire external expertise (Schep, 2010, p. 31). Thus, information sharing is an important feature of economies of scale (Vermeulen , 2015, pp. 134-135).

On this level the Foundation accumulates knowledge in order to develop an expertise in assessments. They want to derive their right to exist from this expertise, a goal which is not proven yet. Assessments are investigating to what extent a client is entitled for certain provisions and support, which are stipulated in a permit. The task for referencing the amount of actual care and support that is needed is another competence, which is predominately performed by consultants or district teams. All cases agree that these tasks should be strictly separated, which was not a dominant thought in the transition-phase.

Although the Shared Vision shares this idea of the separation between assessment and referencing care, they have not the same interest in developing an expertise centre for the region. This corresponds with their informal structure and their wish to respect local autonomy.

The Public Body is effective in accumulating knowledge and expertise by offering better payed and more challenging work to employees from the participating municipalities. Therefore the best civil servants are recruited to work in the Public Body. The Foundation and the Public Body have legal personality which also makes it possible to have its own staff-policy in order to recruit the best employees.

Conditions for Joint Public Body Shared Vision Central effectiveness Body/Foundation Municipality

Integral policy- Participation Act Multiple policy Multiple policy On case-level making fields, adjustment fields aimed at only; especially via portfolio- prevention. with Youth-Law. meetings. Civil society organisations Integration of budgets.

Accumulation of Expertise in health- Recruiting Project groups Project teams. knowledge and assessments. employees from Consultants I-Wmo. expertise Different participating Information- ‘Digital backgrounds municipalities sharing on geographic map’ employees. multiple levels

Development of ‘One package of Innovation Inspiration based Meetings with innovation services’ budgets on Huber’s providers. ‘Positive Health’ Project plans. and the Quality Esbjerg-model standards. Quality systems.

Client- and Participation Clients’ freedom Only in individual Only in individual citizen meetings. of choice as a municipalities municipalities participation Online platform. central objective. Surveys. Implementation tests. Table 8: Overview Conditions for Effectiveness

However, the Shared Vision, develop expertise with civil servants in project groups, which has led to a lot of adjustment and negotiations in order to accumulate the proper knowledge. The Central Municipality only has a mandate for implementing the Wmo, which does not necessitate a lot of negotiation structures. Policy preparation is developed in project groups in which civil servants from the municipalities participate.

On the level of the transformation phase, in which new approaches, innovations and long-term solutions have to be developed (Gemeenten van de Toekomst, 2017), the Foundation has developed one innovation. This has been an initiative of the Foundation and they are working on more innovations. However, there are no structural budgets to stimulate innovation. The Public Body facilitates innovations with innovation budgets. After development, innovations are shared with the market for further exploitation.

The Shared Vision does not facilitate innovations, but has inspiring theories and models onto which they base their policies. The respondents, though, mention that these inspirations are not necessarily put into practice, but especially stimulate a way of thinking, which constitutes a holistic view on the concept of health.

The Central Municipality facilitates innovation especially by guaranteeing quality. These quality standards are developed in project plans which are established in cooperation between the providers and civil servants. They also work online by providing a platform and quality systems. The Central Municipality also adapts to the quality systems that are used by providers and also helps providers developing quality systems if providers do not have any system yet. On this level they are effective according to the law (article 2.3.5. Wmo), but also because it reduces the administrative burden (van der Ham, 2018, p. 9) and improve the accessibility of services for clients (VNG, 2018).

Finally, client participation (article 2.1.3 and 2.6.7 Wmo 2015) is best facilitated within the Foundation because they organise meetings with citizens. Also, they have developed a platform in which clients and citizens can share their thoughts and ideas. Ideas can also count on an implementation test which can- after a positive outcome- be put into practice.

Client participation in the Public Body is served with a central position of clients in choosing a preferred provider. The Shared Vision accommodates freedom of choice, but due to a lack of formalisation, clients and citizens have limited influence in policy making. Nevertheless, citizens can influence policies within their own municipality. Also in the Central Municipality, citizens can participate and influence policies, but it is not clear to what extent they can influence policies in the Central Municipality.

5.3. Management Tools Procurement The Central Municipality Oss uses administrative tender, which benefits from an optimal use of the knowhow of the market (van Eijkel, van Ommen, & Uenk, 2015, p. 23). Bilateral negotiations can lead to a better fit of the quality standards and the providers’ business management. On the other hand, this can lead to information-asymmetry, which benefits the providers’ own interests relative to the interest of the cooperation and clients (van Eijkel, van Ommen, & Uenk, 2015, p. 23).

Management Joint Public Body Shared Vision Central Tools Body/Foundation Municipality Procurement

Tender method Public Tender Dynamic Open house Administrative Zeeuws model contracting and tender management Funding P x Q P x Q P x Q P x Q method Budgets based on Budgets based Budgets based on Fixed average results on results results budget Clients’ 31 providers or Unlimited choice 400-500 providers 200 providers freedom of PGB between 400 Client’s freedom is choice providers central but not unlimited. Monitoring Quality Client surveys Enquiries with the Meetings with instruments inspections Dialogues clients. providers Client surveys Screening Self-reliant matrix Client surveys Screening dossiers dossiers Investigations by SMART budget Supervisor Social Insurance plans Bank and GGZ Option for Almost always Dependent on Almost always used contract used performance renewal Unlimited, but Contract Commonly four Commonly four 1-3 years adjustments are duration years years made every year

Table 9: Overview Management Tools Procurement

The Shared Vision and the Public Body use an open house model which lead to a lot of providers. This leads to an increase in the administrative burden, but also gives clients a lot of freedom. This, in turn, leads to an incentive for providers to deliver additional services, which otherwise- due to a lack of measurability- could not have been stipulated in contracts. Nevertheless with an open house methodology there is a pre-set of minimal quality standards in which providers have to offer their services, to negotiate and be competitive.

The Foundation also moves towards an open house methodology, because the Zeeuws model and public tender has led to impoverishment of certain niche-markets, in which only some investment companies remained in the market.

Every case in this study still uses the P x Q funding method which was already used in the previous AWBZ. This funding method limits innovation because a provider has to deliver the support and care equal to the amount of care and support a client is entitled to, in which there is no incentive to develop new interventions or methods. This method has a perverse incentive to deliver more hours of care than strictly necessary (Uenk, 2017, p. 16).

A risk might be that a cooperation does not have proper monitoring instruments to check the production cost; consequently the pre-set price can lead to inefficiency or can block innovation (van Eijkel, van Ommen, & Uenk, 2015, pp. 23-24). For this reason, three cases are moving toward a budget based on results.

The transformation of a funding method- in which providers are compensated for every hour of service- towards compensation based on results, necessitates a specific understanding of what needs to be achieved (article 2.3.5, 6 Wmo 2015). Also, contracts have to be monitored in order to secure efficiencies, effectiveness and legality (Schep, 2010, p. 45)

This is not always the case. Only the Central Municipality actively works in order to improve quality by forcing providers to write their services SMART (that is: specific, measurable, acceptable, realistic and time-bound). Nevertheless, all cases use client surveys or inquiries in order to monitor the results and screen dossiers in order to investigate quality.

The lowest amount of innovation is with the Central Municipality in this study, because this cooperation has a fixed average price in combination with a P x Q funding method, with the consequence that a provider is secured of income for an entire year independent of any results. P x Q in combination with a budget based on results can overcome this threat, which is the case with the other three cases. As discussed, good monitoring instruments are then required in order to have knowledge about cost structures which makes it possible to adapt the prices to this information (Uenk, 2017, p. 17).

All cases- though limited within the Foundation- facilitate clients’ freedom of choice which can be an efficient tool to regulate the market and to improve customized services (van Eijkel, van Ommen, & Uenk, 2015, p. 38), but this also has to be nuanced. Sometimes immediate support is necessary and freedom, then, is not the most important goal. Also, freedom leads to responsibility, a factor that not every client possesses sufficiently. Moreover, optimal information is not always available for making a considered decision.

The Public Body and the Foundation both have average contract duration of four years. But the option to extend contracts depends on performance within the Public Body and is almost always used within the Foundation, which leads to a relative fixed amount of providers, which can lead to market power and harm the negotiating power of the Foundation. This can increase uncertainty about expenditures (Vermeulen , 2015, p. 138) and thus can harm the attractiveness for new organization to enter the IMC, because effectiveness on an organizational level is limited (Provan & Milward, 2001, p. 420).

Approximately 80% of the market is owned by the 10 biggest providers within the Central Municipality, because the options to extend contracts are almost always used. This market power however does not negatively influences the negotiation power of the Central Municipality.

Other contracts are closed with smaller providers which have led to 200 contracts, in which the clients’ freedom of choice is guaranteed. Finally, in the Shared Vision, the ratio of the market is relative equal among small, medium and large companies, which creates full competition and thus the use of this instrument is effective (van Eijkel, van Ommen, & Uenk, 2015, p. 41).

The contract duration depends on products or services that need to be provided, but a lot of one- year contracts are closed, consequently the proper investments cannot always be made due to limited contract duration for some providers (van Eijkel, van Ommen, & Uenk, 2015, pp. 42-43).

I will now use the results and the analysis in order to clarify to what extent the findings supports the theoretical assumptions. Furthermore I will answer the central research question. Finally I will discuss the limitations of this research and will make suggestions for further research.

6. Conclusion In this study I have analysed how effective different inter-municipal collaborations are in implementing the Wmo. In doing so I have investigated four different inter-municipal collaborations in the Netherlands. I have performed document analysis and conducted eight interviews.

I have elaborated on cooperation characteristics, conditions for effectiveness and procurement instruments in order to detect how effective different collaborations are in implementing the Wmo. I will use the findings in this study to discuss to what extent the cases support the theoretical assumptions regarding the relationship between policy networks and effectiveness. Finally I will answer the central research question and discuss the limitations of the findings and will make some suggestions for further research.

Literature suggests that scale is an important factor for effective inter-municipal cooperation due to a bigger market which leads to more providers, share of resources and investments, share of knowledge and expertise and share of risks (Vermeulen , 2015, p. 138). Theory also suggests that cooperation leads to reduced staff expenses due to specialisation and expertise (Schep, 2010, p. 31).

The investigated cases support this theoretical assumption. In all four cases, resources are shared based on population size of each municipality. Moreover, all cases work together on a joint procurement plan, which reduces staff expenses; create a bigger market in which more providers can enter the market and fosters competition and clients’ freedom of choice. Effectiveness is reached in more complex and specialised customised provisions, because this is more expensive and more knowledge and expertise is required in order to offer specialised care.

Three cases have a financial instrument to prevent strategic behaviour among participating municipalities; if a municipality wants to have an (partial) opt-out, than that municipality has to compensate the other municipalities. Strategic behaviour is mostly provoked by regional frictions, in which a municipality wants to cooperate with other neighbouring municipalities. With this compensation measurement, risks are contained and continuity is safeguarded. For this reason, one case cooperates in a ‘coalition of the willing’ in which the pursuit of joint objectives is possible without the risk to be outvoted or to risk a financial burden.

Furthermore, all respondents explicitly acknowledge the importance of sharing knowledge, but only two cases actually develop an expertise. Especially the separation of assessments and referencing care are denoted as important. One respondent perceives policy outcomes as effective when this is the result of adjustment and negotiating in all layers of the cooperation. Although sharing knowledge is deemed important, three respondents claim too much negotiation structures are ineffective.

Another theoretical assumption is that a same sense of urgency and a common vision are conditional for effective cooperation (Schep, 2010, p. 14). Also, I expected that communication leads to trust and this leads to effective cooperation (Schep, 2010, pp. 38-39).

First of all, it is difficult to define and measure trust. Only Social Domain Achterhoek cooperates based on a shared vision, but nevertheless this does not lead to an all-encompassing cooperation between the participating municipalities, because cooperation is based on coalitions.

Nevertheless, I also cannot argue that this is due to distrust; the reason perhaps might be diverging interests. The Central Municipality Oss is effective due to a clear separation of tasks and responsibilities, but does not have any common vision. Nevertheless, Oss invests a lot in quality systems and quality aspects, which is essential for an effective shared vision (Schep, 2010, p. 14).

Furthermore, ROG plus (Foundation) and RGV (Public Body) also have budget plans and annual plans, but this is based on their mandate and adjustment between multiple actors and layers in the organisation; therefore I could not denote this as a common vision or trust. I can state that negotiating, adjustment and consensus lead to effectiveness, but too much negotiating structures also block effectiveness and therefore cannot conclude how much negotiating structures are effective, because this depends on a particular IMC and specific circumstances.

Finally, I expected that uniform IMC regimes reduce transaction costs and improve local and regional benefits (Klok , Denters , Boogers, & Sanders, 2018, p. 529).

I have no conclusive results about costs regarding negotiation, coordination, monitoring and controlling. Based on our findings I could argue that efforts for transaction are more time consuming within the least uniform IMC, namely the Social Domain Achterhoek. I can also argue that transactions are the least time consuming with the Central Municipality Oss, because Oss has the least negotiating structures and the mandate is transferred to an existing municipality, which means that no new organization had to be established and also limits the amount of coordination. Nevertheless, a Central Municipality is not the most uniform IMC within this study, so I cannot support this theoretical assumption, based on these findings.

I will now answer the central research question.

How effective are different inter-municipal collaborations in the Netherlands in implementing the Wmo?

On a community level, in which services and consequently added value to the community can only be achieved with cooperation (Provan & Milward, 2001, pp. 416-417), I can argue that all cases are effective regarding specialised care. Small participating municipalities, due to a lack of resources and expertise, do not have the capacity to provide specialised care autonomously. Some respondents claim that basic general services can be provided by individual municipalities, because this does not require additional expertise and financial resources.

I can conclude that on a network level, in which an IMC has the capacity to provide basic services, as well as additional services (Provan & Milward, 2001, p. 418), the Public Body is the most effective, because it includes the most policy fields and governing bodies. Furthermore, the Public Body and the Foundation possess the necessary competences and a fixed budget in order to develop integral policies and have an independent staff-policy in order to attract the proper knowledge and expertise.

Nevertheless, the Foundation does not structurally cooperate with other policy fields, thus it does have the capacity to provide additional services in a structural sense. The Central Municipality Oss has a fixed budget and is competent to implement the Wmo and thus has the capacity to provide the basic services, but does not have the competence to develop integral policies in a structural way. Only with complex cases, on a case level, integral services are provided.

Finally, the Shared Vision includes policy fields and civil society organisations which are necessary to provide customised services and consequently can provide additional services as well. But due to a lack of a fixed budget and the necessary competences, continuity of services can be endangered within the Shared Vision. Also, due to a lack of formal competences, integral services have to be developed in an informal way which necessitates complex negotiation structures which are ineffective (Uenk, 2017, p. 15). Nevertheless, the Shared Vision gives the opportunity to test different methods in the same region, which can accommodate to learn from best practices.

6.1. Discussion Besides the positive and the negative consequences of structure characteristics, conditions for effectiveness and procurement instruments on effectiveness regarding the implementation of the Wmo, there is no blueprint for effectiveness. A very formal cooperation with long experience in multiple policy fields with sufficient resources, knowledge and expertise can still be ineffective if it chooses the wrong combination of procurement instruments. A very informal cooperation, in which local interest and autonomy are protected and enough room is available for innovation and the proper procurement tools are used can still be ineffective due to very intensive and complex negotiation structures.

Also, in the transformation phase, collaborations are developing and innovating in their methods, in which the most effective approach may change in the near future. Moreover, the motives for cooperation are sometimes trivial; there is not always a specific reason for choosing a particular form. Sometimes aspects like experience, trust and impulses from the national government have caused a particular cooperation from existing.

Therefore, I cannot conclude that one particular cooperation is more effective than the other. I can conclude that a joint procurement policy is effective. Also, the combination of a budget based on results, freedom of choice and good monitoring instruments leads to an effective implementation of the Wmo in which efficiency and innovation is stimulated. Furthermore, a balanced level of standardization and guaranteed quality will lead to effective outcomes. The problem is that an increase in quality standards will lead to an increase of the administrative burden and is not flexible to specific circumstances, but quality standards are necessary in order to have an effective implementation of the Wmo.

Some limitations of this study is the focus on structure characteristics and less focus on what clients think about the provisions they receive. Therefore it is interesting to include consultants, social teams and clients in further research and broaden the scope of respondents. Furthermore, the transformation phase is an ongoing process, so it is interesting to conduct this study again in a few years and also including more different inter-municipal collaborations, because this study is limited with four different cases.

Therefore I cannot generalize the findings to all corresponding collaborations in the Netherlands. Moreover, our results largely depend on document analysis and perceptions of effectiveness, so I cannot claim any causality. Perhaps a comprehensive statistical analysis will increase validity. Finally, all cases are collaborating in multiple negotiation structures which make it interesting to focus on aspects such as trust. Perhaps the relationship between trust and transaction costs can be investigated in further research.

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Appendices

Appendix I: Email to municipalities

Dear Sir/Madam,

I am writing you regarding my master’s thesis about inter-municipal cooperation in the Wmo. First of all, I would like to introduce myself.

My name is Donné de Ruijter and I am a Public Administration student at Tilburg University. In the context of my master’s thesis, I am investigating different inter-municipal collaborations in the Netherlands and to what extent different inter-municipal collaborations are effective in implementing the Wmo.

Therefore I would like to request two respondents who are willing to provide an interview of approximately 30 minutes each. I would like to interview a respondent who has a strategic position, in which I would like to discuss to what extent integral policies are developed, to what extent policy innovations are developed, to what extent citizens can participate in policy preparation and/or development in the organization and why the organization has chosen their particular collaborative form. Furthermore, I also would like to interview a respondent who has an occupation in the procurement division, in which I hope to discuss tender methods, funding methods, monitoring instruments, clients’ freedom of choice and how the respondent perceives effectiveness of these procurement instruments.

I will make sure that I will be properly prepared. You can contact me anytime by email and phone number which is attached below.

Thank you in advance.

Kind regards,

Donné de Ruijter

Appendix II: Interview questions

Name inter-municipal cooperation (IMC):

Respondent:

Interviewer:

Date:

Place:

Introduction First of all, I would like to thank you for this interview. I will introduce myself and tell something about the aim of my research and what I would like to discuss within this interview.

My name is Donné de Ruijter and I am a Public Administration student at Tilburg University. My master’s thesis is aimed at investigating how effective different inter-municipal collaborations are in implementing the Wmo. I would like to discuss how you perceive effectiveness in the context of integral policy development, the development of innovations and the involvement of citizens in policy preparation. Furthermore I would like to discuss multiple procurement instruments for regulating the market, in order to have an effective output of care and support. I would like to discuss these aspects based on multiple structure characteristics of this IMC, such as the legal form, scale, number of participants, the involved policy fields and involved governing bodies.

Moreover, with your consent I would like to record this conversation, which will be only used in order to make transcripts and compare the results of the interviews. You will be anonymised and your statements will be treated confidentially; all recordings and transcript will be destroyed after they have been processed. The interview approximately takes 30 minutes with a maximum of one hour. Do you have any questions before I proceed?

Introduction questions

1. Can you tell me something about your occupation in this organization? 2. How long do you work in this organization? 3. Do you have any other experience in this line of work?

Questions about the IMC

4. Why has there been chosen for this particular collaborative form? - What are the advantages/possibilities? - What are the disadvantages/limitations? 5. How many negotiating structures are there? - How many participants are involved? - Do the participants of these meetings meet frequently? - Do you perceive this as effective and why so? 6. How many governing bodies are involved in the IMC? - Does this improve integral policy making? - Do you perceive this amount as effective and why so?

7. How many policy fields are involved in the IMC? - Which policy fields cooperate? - Is cooperation structural or only on case level? - Are budgets integrated? - Are integral policies or services developed? - How do you perceive the quality and effectiveness of integral policies or services? 8. Does the IMC develop innovative policies or services? - How are these innovations developed or facilitated? 9. Can citizens or clients participate in policy preparation or development within the IMC? - How does the IMC facilitate this? - What does the IMC do with this input in practise?

Questions about procurement

10. What tender method is used regarding the Wmo? - Why has there been chosen for this method? - What are the advantages/possibilities of this method? - What are the disadvantages/limitations of this method? - How does this interact with the other procurement instruments? - Do you perceive this method as effective? 11. Which funding method is used in this IMC? - Why has there been chosen for this method? - What are the advantages/possibilities of this method? - What are the disadvantages/limitations of this method? - How does this interact with the other procurement instruments? - Do you perceive this method as effective? 12. Which monitoring instruments are used? - How does this interact with the other procurement instruments? - Do you perceive this method as effective? 13. To what extent do clients have freedom of choice in choosing their provider? 14. Are the options for contract renewal commonly used? 15. What is the average contract duration? 16. To what extent are contract flexible?

Conclusion I would like to thank for your time and effort, but I have no further questions. Do you have any questions or remarks? Thanks again, you can contact me anytime if you have questions left. I can send the report if you like.

Appendix III: Document analysis

Cooperation Function Date Time Preparation documents Respondent A Board Secretary 30-5-2018 10.30-11.30 Government Public Body gazette2 Budget program and website

Respondent B Contract manager 30-5-2018 11.30-13.00 Budget program Public Body and website

Respondent A Contract manager 04-6-2018 10.00-12.003 Government Foundation gazette Annual report

Respondent B Policy officer 04-6-2018 10.00-12.00 Website Foundation quality Budget program

Respondent A Program manager 18-6-2018 14.30-15.05 Government Centre care and Ilfare gazette Municipality Budget plan

Respondent B Contract manager 18-6-2018 15.05-15.45 Website Centre Municipality

Respondent A Principal 19-6-2018 10.30-11.55 Regional Vision Shared Vision department society Respondent B 19-6-2018 14.30-15.00 Website Shared Vision

2 This is the source in which the collaborations are established in a legal sense. 3 This interview was conducted with respondents at the same time.