Institutional change in UK health and local authorities (original) (raw)
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Public Administration, 2016
Since the beginning of the 1990s the public health care system in England has been subject to reforms. This has resulted in a structurally hybrid system of public service with elements of the market. Utilising a theory of new institutionalism this paper explores National Health Service (NHS) managers' views on competition and cooperation as mechanisms for commissioning health services. We interrogate the extent of institutional change in the NHS by examining managers' understanding of the formal rules, normative positions and frameworks for action under the regime of the Health and Social Care Act 2012. Interviews with managers showed an overall preference for cooperative approaches, but also evidence of marketisation in the normative outlook and actions. This suggests that hybridity in the NHS has already spread from structure and rules to other institutional pillars. The study showed that managers were adept at navigating the complex policy environment despite its inherent contradictions.
Competition, Cooperation, Or Control? Tales From The British National Health Service
Health Affairs, 1999
In the battle between market competition and central control in Britain's health care system, control won. Will Labour's new version of the market prevail? by Julian Le Grand PROLOGUE: In July 1998 the British National Health Service (NHS) marked its fiftieth anniversary. The NHS brought together in one organization, for the first time, hospital, physician, and community health services-and also posed administrative and fiscal challenges that continue to plague it. Britain undertook the latest in a series of reforms after the New Labour party assumed power in 1997. This latest reform, which represents a "third way" between the poles of liberal and conservative, focuses more on collaboration and less on the competitive principles of the previous internal-market reforms of Britain's Conservative government. In this paper Julian Le Grand discusses "the evidence concerning the internal market's effectiveness," building on a paper published in Health Affairs last July (Rudolf Klein, "Why Britain Is Reorganizing Its National Health Service-Yet Again"). Following Le Grand's paper is a series of Perspectives, focusing both on the NHS reforms and on another endeavor under way in Britain: an attempt to address inequalities in health, based on a study of the social determinants of health and poverty. This discussion has implications for other health care systems as they seek to improve their citizens' health in an era of cost constraints. Le Grand is Richard Titmuss Professor of Social Policy at the London School of Economics and holds a doctorate in economics from the University of Pennsylvania. He has served as an adviser to the World Bank and the European Commission, and is prominent in Britain as an advocate of the "third way."
Environment and Planning A, 1995
The process of compulsory competitive tendering (CCT) for the provision of local-government services has forced significant changes to the way in which such services have been provided, whether such services have been contracted out or remain in-house, and has spawned a considerable literature on the impact of these changes on the quality, reach, and cost of public services. The primary focus of this literature has been on service users (or ‘consumers’) and the local taxpayer. In this paper, however, we attempt an analysis of these changes in terms of their impact on the nature of work within public sector services. Empirical evidence of geographical and sectoral variations in the degree of success of the private sector in winning contracts is considered, and explanations for these variations are offered. In particular, the discussion focuses on variations in the form of work in different sectors and the treatment of workers in different places and in different types of services, th...
The policy and politics of healthcare corporatisation: The case of the English NHS
Social Science & Medicine, 2024
Few accounts of healthcare corporatisation examine the effects of the 2008 financial crisis. New Politics of the Welfare State (NPWS) theories recognise the relevance of crises but give more attention to programmatic than systemic (structural) retrenchment, and little to healthcare corporatisation. Objective: To examine what changes the 2008 financial crisis produced in the pattern of healthcare corporatisation, and the implications for NPWS theories. Methods: Using administrative data from the English NHS during 1995-2019 we formulated a multi-dimensional index of corporatisation, tested its validity, and used it to analyse longitudinally how the financial crisis affected the balance between the responsibilization of management and re-commodification (introduction of market-like practices) in provider corporatisation. Results: The financial crisis influenced NHS corporatisation through the fiscal austerity with which governments responded. The re-commodification of NHS providers stalled but not the responsibilization of NHS managers. Conclusions: The corporatisation of NHS providers faltered after the financial crisis. These findings corroborate parts of NPWS theory but also reveal scope for further elaborating its accounts of systemic retrenchment in health systems.
Public Management, 2000
Cur rent Engl ish pol icy tow ard s gener al pr act ice is a mbi val ent be tween devel oping ne w for ms of cont ra ctu al gove rnanc e and cons truct ing mor e h ierarc hic ally or gani ze d bo die s. NHS pol icy docume nts s ay that Primar y Care Tru sts (PCTs) will cont ract some pr imar y car e ser vices and dire ctly m anage ot her s. Dependi ng on the bal ance , PCTs c oul d either orga niz e gene ral pr act ice thr ough pr act ice-based c ontr act s or start deve lopi ng into hier archi es (albei t with som e subc ont rac tor s for the time bei ng) .