Local histories and local sensemaking: a case of policy implementation in the English National Health Service

Coleman, Anna; Checkland, Kath; Harrison, Stephen; Hiroeh, Urara

doi:10.1332/030557309x462547

Cited by 27 publications

(31 citation statements)

References 13 publications

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“…Whilst we did observe occasional examples of commissioners making such choices, it was notable that this only occurred at the margins, involving small volumes of straightforward elective care. What is striking is that these findings are strongly redolent of research findings from earlier phases of the NHS purchaser/provider split, in that formal changes in transaction rules are mediated through pre-existing social and institutional arrangements (Flynn et al, 1996;Ferlie, 1994;Hughes et al, 1997;Mays et al, 1998). In more abstract terms, commissioning has remained a relational (Powell, 1991) rather than an economic phenomenon, embedded (Granovetter, 1995) in existing social and institutional structures.…”

Section: Discussionmentioning

confidence: 75%

Commissioning in the English National Health Service: What's the Problem?

et al. 2012

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AbstractThe English NHS is currently organised around a split between the ‘commissioning’ and the ‘providing’ of health care. There has been considerable critical comment about commissioning, focusing upon perceived inadequacies of the regulatory structure and a perceived lack of competence of the managers concerned. In this paper, we use empirical data from two detailed studies of commissioning to propose a third explanation of the difficulties that have been observed in making commissioning work. We apply Scott's institutional analysis to the issue, arguing that far from reflecting managerial incompetence, some of the difficulties experienced are inherent in the normative and cultural/cognitive pillars of the NHS institution, so that there is a lack of ‘fit’ between commissioning and the institutional characteristics of the NHS. We conclude by exploring the potential impact of the latest round of NHS changes on this institution.

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Section: Discussionmentioning

confidence: 75%

Commissioning in the English National Health Service: What's the Problem?

et al. 2012

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“…It builds on recent research examining the way that commissioning is understood and undertaken locally,5–7 the spaces in which commissioning takes place8 and the people involved 9 10. The focus is on the commissioning of services for people with long-term conditions.…”

Section: Introductionmentioning

confidence: 99%

The work of commissioning: a multisite case study of healthcare commissioning in England's NHS

et al. 2013

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ObjectiveTo examine the work of commissioning care for people with long-term conditions and the factors inhibiting or facilitating commissioners making service change.DesignMultisite mixed methods case study research, combining qualitative analysis of interviews, documents and observation of meetings.ParticipantsPrimary care trust managers and clinicians, general practice-based commissioners, National Health Service trust and foundation trust senior managers and clinicians, voluntary sector and local government representatives.SettingThree ‘commissioning communities’ (areas covered by a primary care trust) in England, 2010–2012.ResultsCommissioning services for people with long-term conditions was a long drawn-out process involving a range of activities and partners. Only some of the activities undertaken by commissioners, such as assessment of local health needs, coordination of healthcare planning and service specification, appeared in the official ‘commissioning cycle’ promoted by the Department of Health. Commissioners undertook a significant range of additional activities focused on reviewing and redesigning services and providing support for implementation of new services. These activities often involved partnership working with providers and other stakeholders and appeared to be largely divorced from contracting and financial negotiations. At least for long-term condition services, the time and effort involved in such work appeared to be disproportionate to the anticipated or likely service gains. Commissioners adopting an incremental approach to service change in defined and manageable areas of work appeared to be more successful in terms of delivering planned changes in service delivery than those attempting to bring about wide-scale change across complex systems.ConclusionsCommissioning for long-term condition services challenges the conventional distinction between commissioners and providers with a significant amount of work focused on redesigning services in partnership with providers. Such work is labour-intensive and potentially unsustainable at a time of reduced finances. New clinical commissioning groups will need to determine how best to balance the relational and transactional elements of commissioning.

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“…We found that PBC had made a good deal of progress, albeit with considerable local variation 13 and sometimes restrained by perceived organisational 'barriers'.…”

Section: Discussionmentioning

confidence: 89%