The business of the NHS: The rise and rise of consumer culture and commodification in the provision of healthcare services

Abstract

The implementation of market reforms has transformed the National Health Service (NHS) from a single national healthcare provider to a complex conglomeration of national and private organisations providing healthcare under the umbrella of the NHS brand. Private and state-run organisations compete to provide services to increasingly knowledgeable and entrepreneurial healthcare consumers. As a result, the NHS has become more and more business-like and is subject to the same consumer drivers that can be identified elsewhere in society. Healthcare consumers are not typical 'customers', however, since most consume NHS services out of necessity and the state funds the care they receive. Yet it is this 'necessity' of consumption that makes contracts to provide services on behalf of the NHS such a valuable commercial opportunity for private providers. This paper examines how consumer culture has influenced attitudes towards health and dying and is contributing to the creeping commodification of healthcare consumers themselves.

“The citizen is stepping into a new role”—Policy interpretations of patient and public involvement in Finland

“…The "demanding and sceptical citizen consumer" described by Clarke, Newman, Smith, Vidler, and Westmarland (2007) is strongly present in Finnish health policies, following a similar trend to other countries (Newman & Kuhlmann, 2007;Sturgeon, 2014). Addressing people as customers and service users enables policy documents to position them as the active drivers of reform, modernisation and increased choice.…”

Nonprofit organizations in between the nonprofit and market spheres: Shifting goals, governance and management?

“…This can be observed through the presence of subtle exclusion mechanisms vis-à-vis participatory workers in work integration social enterprises (Hustinx & De Waele, 2015), a shift from tailored to a one size fits all service provision (Gallet, 2016), and decreased accessibility to nonprofit services due to increased attention for those who can pay instead of for those who are in need (Khieng & Dahles, 2015). -Increased competition from for-profit providers as a learning opportunity for operational improvement (Froelich, 2012) -Resistance mechanisms, such as, unionization (Baines, 2010;Baines, Charlesworth, Turner, et al, 2014) -Social redefinition of business-like discourse (Sanders & McClellan, 2014) Commercialization (development of commercial activities) -Risk of mission drift, that is, risk of financial goals overriding social goals (Khieng & Dahles, 2015) -Decrease in accessibility to organizational activities ("shift from those who need to those who are able to pay") (Khieng & Dahles, 2015;Salamon, 1993) -Negative relationship between commercial revenue and goal fulfillment (Thompson & Williams, 2014) -Increased transparency vis-à-vis staff & beneficiaries (Khieng & Dahles, 2015) -Crowding out of professionally nonactive volunteers (Enjolras, 2002b) -Crowding out of private donations (mitigated by mission consistency & entrepreneurial competency) (Smith, Cronley, & Barr, 2012) -No crowding out of voluntary and public resources (Enjolras, 2002a) -Inverse relationship between commercial revenue and donative income (Guo, 2006;Salamon, 1993;Young, 1998) -Limited relationship between donative-and commercial revenue (Kerlin & Pollak, 2011;…”

“…Internally, a managerial organization is characterized by a close control over operational processes, interchangeably manifested through (a) the presence of performance measurement (Carnochan et al, ), (b) standardization of organizational processes (Baines, Cunningham, & Fraser, ), (c) the use of corporate management tools (Hvenmark, ), or (d) the introduction of managerial professionals (Hwang & Powell, ). Externally, managerialism induces an economic outlook on the organizational environment that consists out of “products, consumers and investors.” This in turn can be related to the concepts of “consumerism” (clients become consumers), “commodification” (nonprofit services and goods become commodities produced in accordance to market demand), “market‐orientation” (stakeholder communication becomes marketing), and “venture philanthropy” (donations become investments) (see e.g., Chad, Kyriazis, & Motion, ; Edwards, ; Garrow & Hasenfeld, ; Sturgeon, ).…”

Patient and public involvement facilitators: Could they be the key to the NHS quality improvement agenda?

“…Early forms of PPI were triggered by activists and lobbyists wanting more public accountability in health services, for example Community Health Councils in the 1970s . The nature of PPI has evolved with the notion of the health‐care ‘consumer’ and quasi‐marketization during the 1980s and 1990s . It has been argued that PPI encompasses a wide range of activities that can be summarized as the exercise of ‘choice’ (consumers choose which service to access), ‘voice’ (consumers say what they want from their own care and wider services) and ‘exit’ (consumers can leave if they are unhappy) …”