New localism in the English National Health Service: What is it for? (original) (raw)
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Social Science & Medicine, 1998
ÐThe creation of a large managerial stratum within the British National Health Service in recent years has been one of the most striking characteristics of reforms intended to develop a more ecient and``business-like'' service. An accompanying political rhetoric of decentralisation has cast local managerial autonomy as a means to gauge and respond more easily to the needs and preferences expressed by local communities. This article therefore reviews the growth of the new managerial stratum with particular regard to its emerging relationship with the local populations in whose name the organisational reforms have been wrought. The dominant political interpretation of this relationship Ð that the organisational reforms constitute a movement from leaden``bureaucratic'' administration to more locally accountable and responsive managerial regimes Ð is then tested with regard to an indepth study of two health authorities responsible for very dierent local populations. Results show that the role of local populations in in¯uencing decisions and determining priorities is considerably less than inferred by the sustained political rhetoric in favour of the``local voices''. Consideration of possible trends in the state and economy suggests however that this disjuncture may not be explicable solely in terms of the new managerial stratum maximising its in¯uence or of central government retaining a high degree of control.
Decentralizing Health Services: More Local Accountability or Just More Central Control?
Public Money & Management, 2005
This article examines the continuing debate about, and inter-relationship between, the NHS, decentralization and local participation. The focus of the article is the experience of decentralization and participation over the past 25 years and, drawing on a new conceptualization of decentralization, it identifies the extent to which the NHS supports decentralized approaches to participation.
Decentralizing Health Services: More Local Accountability or Just More Central Control&quest
Public Money & Management, 2005
This article examines the continuing debate about, and inter-relationship between, the NHS, decentralization and local participation. The focus of the article is the experience of decentralization and participation over the past 25 years and, drawing on a new conceptualization of decentralization, it identifies the extent to which the NHS supports decentralized approaches to participation.
For Debate Local government and the National Health Service: the new agenda
Journal of Public Health, 1997
There are some interesting paradoxes in the relationship between local government and the National Health Service (NHS). Local government is responsible for a range of major services, many of which relate to health broadly defined. The NHS provides many services which are often popularly thought to be part of local government (and, indeed, in many countries are). Local government prides itself on its 'localness'; the NHS, with its services delivered in a very local fashion for the most part, cannot quite decide whether it is a national service or a local one. Yet these two major agencies of governance and public service provision often seem unable to work very well together. In the interests of good government, both agencies need to work together where their interests coincide or abut one another. Differences of perspective, priority, culture and style need to be recognized but resolved. Opportunities for joint working need to be grasped and the experience built on. The paper looks at a series of issues and opportunities which bring local government and the NHS together. They create an incentive to improve working relationships; at the same time they suggest an agenda of future possibilities.
Still a fine mess? Local government and the NHS 1962 to 2012
Journal of Integrated Care, 2012
Purpose-The purpose of this paper is to take 'a long view' of initiatives taken to promote integration between local government and the NHS with the objective of seeking to understand why they have achieved consistently disappointing results. Design/methodology/approach-The paper's analysis is based on a historical overview drawn from official documents and empirical research from the time of the creation of the NHS in 1948, but primarily focussing on the principles shaping the separate but parallel reorganisations of 1974 and their continuing influence up to and including the current White Paper, 'Liberating the NHS', and the Health and Social Care Bill. Findings-The fundamental sources of integration barriers today lie in the foundational principles of basing (a) their responsibilities on the skills of providers rather than the needs of service users and (b) their organisational forms on separation rather than interdependence with national uniformity driving the NHS and local diversity local authorities. In addition, frameworks for integration have been established on a paradigm of seeking to build bridges at the margins of organisations rather than seeking to interweave their mainstream systems and processes. Research limitations/implications-Future empirical research will be necessary to establish whether the currently proposed arrangements for integration do, in fact, experience the same limited results as previous ones. Practical implications-Local and national strategies for improving integration should be reviewed in the light of the understandings set out here and local frameworks should seek to align and integrate mainstream systems and processes so far as possible. A thorough and dispassionate analysis should conducted of whether a free-standing, single purpose, national organisation still provides the most appropriate structure for delivering health services in light of changing needs, care models and resources. Originality/value-The paper provides offers a distinctive analysis of the possible causes of disappointing outcomes from successive attempts to improve integration. If accepted it 1 This paper was one of a number commissioned for a special issue marking the 20 th anniversary yof the
Primary care in the UK: understanding the dynamics of devolution
Health and Social Care in the Community, 2001
The United Kingdom is ostensibly one country and yet public policy often varies between its constituent territories -England, Scotland, Wales and Northern Ireland. Health policy illustrates the dilemmas inherent in an apparently unitary system that permits scope for territorial variation. Administrative devolution has now been accompanied by political devolution but their interaction has yet to produce policy outcomes. This paper describes recent health policy reform with regard to primary care in terms of the tension inherent in current policy between notions of a 'one nation NHS' and the territorial diversity wrought by devolution. The paper provides a framework for understanding the emergent outcomes by exploring various concepts. In particular, the existing character of territorial policy networks, the properties of policies in devolved territories and intergovernmental relations are considered from various disciplines to examine whether greater diversity or uniformity will result from the dual reform process. Whilst this evaluation can, at this stage, only be preliminary, the paper provides a framework to appraise the emerging impact of devolution upon primary care in the UK.
Institutional change in UK health and local authorities
International Journal of Social Economics, 1999
The programme of market‐oriented reforms to the UK’s welfare state commenced during the 1980s with the implementation of the competitive tendering of certain defined activities in health and local authorities. This paper argues that mainstream economic analysis offers only a very partial analysis of this policy; merely reducing investigation to a comparison of costs across alternative governance arrangements. It is contended that the old institutionalist account of institutional change provides a richer anaytical vein. The paper concisely applies this in a survey of 21 authorities. Results indicate that the policy engendered change in the values correlating behaviour by partially supressing established welfarist values. There was also some deterioration in trust between parties with the formalisation of relationships, although this varied between health and local authorities. The new contracting environment and decline in staff morale may have contributed to increased rigidities.