Alternative governance for public service delivery? : the role of Community Interest Companies in the English NHS (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.
Healthcare Providers in the English National Health Service
International Journal of Public and Private Healthcare Management and Economics, 2011
In recent years it has been noted that boundaries between public and private providers of many types of welfare have become blurred. This paper uses three dimensions of publicness to analyse this blurring of boundaries in relation to providers of healthcare in England. The authors find that, although most care is still funded and provided by the state, there are significant additional factors in respect of ownership and social control which indicate that many English healthcare providers are better understood as hybrids. Furthermore, the authors raise concerns about the possible deleterious effects of diminishing aspects of publicness on English healthcare. The most important of these is a decrease in accountability.
Social Science & Medicine, 2006
The article considers the role of public involvement in the NHS in the context of the wider shift from government to governance. Based on a comparative case study, it identifies different outcomes, from a single policy initiative in two localities. It argues, following Jessop, that accounts which rest on inter-organizational relationships are inadequate, and that we also need to look at inter-systemic and inter-personal levels for more complete explanations. Investigating the relationships between these levels, we derive an account of governance within which to situate the role of public involvement. It is against this background that we focus on why the methods of involvement deserve greater attention for their substantive contribution to its quality and effectiveness.
The third sector, patient communities and the changing NHS in England
'Third sector' organisations are being drawn into the heart of healthcare provision under new financing and delivery arrangements for the English NHS. Yet we know little about the effect of the new market upon the relationship of such organisations with their clients and with local community bases. This paper addresses this issue through a case study of the reconfiguration of provider arrangements under the Health and Social Care bill in one English city, drawing on research conducted in 2011 (focus groups and interviews). We explore third sector stakeholders' concerns and strategies for their organisation in the run up to the expected NHS reforms. Specifically we consider whether existing forms of connections between organisations and their local client bases are likely to change and, if so, whether they will be lost, diminished or enhanced and the implications of that this may have for the kind of care provided. Our analysis shows that respondents have a highly develop...
Repositioning the Boundaries between Public and Private Healthcare Providers in the English NHS
Journal of Health Organization and Management, 2019
Purpose-Neo-liberal "reform" has in many countries shifted services across the boundary between the public and private sector. This policy reopens the question of what structural and managerial differences, if any, differences of ownership make to healthcare providers. The purpose of this paper is to examine the connections between ownership, organisational structure and managerial regime within an elaboration of Donabedian's reasoning about organisational structures. Using new data from England, it considers: how do the internal managerial regimes of differently owned healthcare providers differ, or not? In what respects did any such differences arise from differences in ownership or for other reasons? Design/methodology/approach-An observational systematic qualitative comparison of differently owned providers was the strongest feasible research design. The authors systematically compared a maximum variety (by ownership) sample of community health services; out-of-hours primary care; and hospital planned orthopaedics and ophthalmology providers (n ¼ 12 cases). The framework of comparison was the ownership theory mentioned above.
NEW FORMS OF PROVIDER IN THE ENGLISH NATIONAL HEALTH SERVICE
Annals of Public and Cooperative Economics, 2011
ABSTRACT‡: A wide ranging set of reforms is being introduced into the English National Health Service (NHS). They are designed to increase the market-like behaviour of providers of care with a view to improving efficiency, quality and responsiveness of services. This paper is concerned with one aspect of those reforms: namely the policy to increase the diversity of types of providers of care to NHS patients. In this context, increasing diversity means that providers will not all be standard publicly owned NHS organizations. They can ...
business.mmu.ac.uk
Our objectives in this working paper are twofold. Firstly, to put pen to paper and grapple with the issues and starting point for looking at the relationships between the NHS and TSOs. Secondly, to outline our recent award of a 12 month ESRC funded Business Engagement Opportunities Scheme that seeks to engage with the debate and add to the growing body of knowledge around the subject. Health and social care are provided in developed economies by the state, the market, the household and voluntary agencies in combinations that vary across time and place. In England (and in the devolved administrations of the UK) governments have put mechanisms in place to ensure that more public services will be delivered by organisations from the Third Sector (including but not limited to social enterprises), especially for individuals and groups the public sector finds hardest to reach. After decades of a national health service (post WWII) a more diverse set of current and potential providers to address social and health inequalities is among the objectives of the national programme World Class Commissioning. For many TSOs this agenda for change has profound implications that are both welcomed and feared. There are opportunities to develop new and relatively reliable funding streams and to escape dependency on donations and grants. Yet, as many see it, there are new threats to the values of individual organisations and to the distinctiveness of the sector. Becoming more entrepreneurial can be associated with being adaptable and responsive to opportunities and the 'market'; or it can seem to signal weakening of charitable, social and voluntary ethos. NHS Manchester has developed a strategic plan of which a key priority is to reshape its local provider profile through market making and commissioning new service contracts from TSOs, especially social enterprises. It is clear that much learning is needed on both sides to make this achievable.