Foundation Trusts and the Problem of Legitimacy (original) (raw)
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Foundation Trusts: economics in the 'postmodern hospital
Journal of Nursing Management, 2005
Foundation Trust Hospitals are community-controlled health care providers which have increased autonomy about how they produce outcomes for the British National Health Service. Although there is a literature on hospital economics it is unclear how these innovative providers will behave, if they have to compete for scarce resources with other hospitals. This paper reviews some of the earlier theories, such as the neoclassical theory of the firm, and discusses their relevance along with 'newer' economic theories such as the transaction costs and evolutionary theory of the firm, plus organizational and human resources theory, to the performance of Foundation Trusts. Much contemporary health care provision is shaped along modernist lines, using scientific endeavour to maximize the impact on health outcomes and technical and social efficiency. However, there is an increasingly postmodern standpoint -critical of modernity -being taken by both patients and hospital staff, to deconstruct processes in the organizations that serve them. Foundation Trusts are postmodern hospitals insomuch as they (to attract scarce resources in a competitive environment), need to marshal the diverse theories of the firm together in order to provide a mass-customized, quality experience, transparently and at least cost -whilst maintaining a stable organizational culture for staff.
Between Organizations and Institutions. Legitimacy and Medical Managers
Public Administration, 2000
This article focuses on how the National Health Service, as a major public service organization, operating in a dynamic environment and utilizing complex processes of human interaction to deliver health care, creates and manages legitimacy. During the late 1990s the NHS embodied a particular series of changes which demanded novel responses from managers, clinicians and service users in relation to governance and professional standards. Most challenging of all are the attempts being launched to exert influence over the organization and management of clinical services, through clinical governance systems which create 'shared forums' for quality improvement (Scottish Office/Department of Health 1998). The emphasis here is to draw upon theoretical constructs of legitimacy and discourse as organizing schema for making sense of such change processes. The role of doctors who assume managerial duties will be examined as a prominent feature of the reform programme.
Investigating the governance of NHS Foundation Trust'
2010
Background NHS Foundation Trusts (FTs) are a new form of NHS organisation set up in 2004. They were conceived as a new kind of organisational form, still part of the NHS, but modelled on 'co-operative and mutual traditions'. FTs are different from other NHS Trusts in two distinct ways: First, they have greater autonomy, and less accountability to the central NHS. They have greater scope to decide how they organise themselves internally, in order to deliver high quality services and control costs.
2019
The aim of this thesis is to explore the role and nature of Community Interest Companies (CICs) in the delivery of health care services in the English NHS. CICs are a hybrid form of organisation insofar as they exist to generate wider social impact through their commercial practices. The thesis draws on theories of New Public Management and Governance to trace the changing role of the state in the context of public service delivery and highlights how these shifts facilitate the growth of alternative providers like CICs in publicly funded health care. To achieve this aim the thesis explores a number of connected questions analysing whether CICs are a new form of governance in health service delivery or the Emperor’s New Clothes? Is the claim to a wider social mission and greater accountability exclusive to CICs? Or could other providers of health care, both private and public, make a similar claim by virtue of what they do rather than their legal status? To this end the study exami...
Lessons from New Zealand for England's NHS Foundation Trusts
Journal of Health Services Research & Policy, 2004
The legislation to devolve responsibility for the management and operation of England's top-performing NHS hospitals to community-owned NHS Foundation Trusts raises several issues relating to the challenges posed to governance structures by private non-profit ownership and control of assets used to provide government-financed services. Building upon the lessons learned from devolution of public hospital governance in New Zealand to boards at arm's-length from central control during the 1990s, this paper analyses the English NHS hospital changes. Whilst local political accountability and competition between hospitals indicate that the English reforms may be more successful in meeting patients' needs more efficiently than the New Zealand reforms, the English proposals may be compromised by the ability of staff to become members of Trusts, boards bearing risks of decisions outside their control whilst simultaneously being insulated from the consequences of their decisions b...
Social Policy & …, 2011
In addition to introducing markets and market-like structures into public services, New Labour wished to promote the involvement of users and the public in decision-making in other ways than as individual consumers. One way was to involve the public in the governance of organizations. This could be done by removing public services from state control, and transferring them to mutual ownership; or by increasing public involvement in the governance of public bodies. NHS foundation trusts (FTs) were presented as mutuals. Our study shows FTs are not mutuals, as they continue to be owned by the state. Moreover, staff of FTs were generally not engaging with the new governance structures. In general, there was mixed experience of the new structures enabling governors to increase accountability of the hospitals to the public. On the other hand, having a membership did enhance the legitimacy of FTs, as opposed to other NHS organizations. The findings of the study are of current interest as the coalition government is continuing with the policy of FTs, and also encouraging mutuals and other forms of public involvement.
New localism in the English National Health Service: What is it for?
Health Policy, 2006
This paper discusses the decentralisation in the English National Health Service (and the new organisational form of Foundation Trusts, in particular) in the context of the trend for decentralising public services generally since the New Labour government started its second term of office in 2001. It considers the likelihood of decentralisation achieving the aims policy makers have set: these are better services and an increase in local people's participation in the planning and running of services (active citizenship). Looking at the evidence to date, both about decentralisation of health services and about Foundation Trusts, the achievement of these goals seems uncertain. desirable to involve the 'community' in local decision making about public services . The latter idea is about process, while the former is about outcomes. It is possible that these two objectives are not always achievable. The paper will discuss how the ideas are articulated, and what the evidence to date shows about the likelihood of success, in the case of the NHS, and FTs, in particular.