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The year 2020 is an epochal moment for governance and public administration. The outbreak of the COVID-19 pandemic has upset social and economic life, including the delivery of public services, and eroded domestic and international politics. It comes in an era of uncertainty resulting from the end of the New Public Management boom and a looming breakdown of the contemporary US-defined international order. Against such a sea change, we can hardly take business as usual. Change breeds indeterminacy but also induces reimagining. Any renewal and renaissance of public management has to address the ‘what’ and ‘how’ questions of governance in a low-trust and high-risk society. Both the capacity and legitimacy of the state need to be re-empowered, but no longer through the market. The dual failure of democratic politics and bureaucratic excellence in many countries has rendered the Wilsonian politics-administration dichotomy redundant. Amid the rise of East Asia, there are growing contentions over the conceptualization of meritocracy as alternative systems of governance and public service models seem to be delivering effective rivals. Governance performance may not be predetermined by regime types within a poly-polar world. We need to search for new reconnections, new leadership, a new basis for trust and consensus, and a new public service bargain to avoid getting bogged down in old wine in re-labelled bottle, or another singular universalist paradigm.

The Models of Child Health Appraised (MOCHA) project identified the different models of primary care that exist for children, examined the particular attributes that might be different from those directed at adults and considered how these models might be appraised. The project took the multiple and interrelated dimensions of primary care and simplified them into a conceptual framework for appraisal. A general description of the models in existence in all 30 countries of the EU and EEA countries, focusing on lead practitioner, financial and regulatory and service provision classifications, was created. We then used the WHO ‘building blocks’ for high-performing health systems as a starting point for identifying a good system for children. The building blocks encompass safe and good quality services from an educated and empowered workforce, providing good data systems, access to all necessary medical products, prevention and treatments, and a service that is adequately financed and well led. An extensive search of the literature failed to identify a suitable appraisal framework for MOCHA, because none of the frameworks focused on child primary care in its own right. This led the research team to devise an alternative conceptualisation, at the heart of which is the core theme of child centricity and ecology, and the need to focus on delivery to the child through the life course. The MOCHA model also focuses on the primary care team and the societal and environmental context of the primary care system.