TY - JOUR
T1 - Being autonomous and having space in which to act
T2 - commissioning in the ‘new NHS’ in England
AU - Checkland, Katherine
AU - Dam, Rinita
AU - Hammond, Jonathan
AU - Coleman, Anna
AU - Segar, Anne
AU - Mays, Nicholas
AU - Allen, Pauline
PY - 2017
Y1 - 2017
N2 - The optimal balance between central governmental authority and the degree of autonomy of local public bodies is an enduring issue in public policy. The UK National Health Service is no exception, with NHS history, in part at least, a history of repeated cycles of centralisation and decentralisation of decision making power. Most recently, a significant reorganisation of the NHS in 2102-13 was built around the creation of new and supposedly more autonomous commissioning organisations (Clinical Commissioning Groups – CCGs). Using Bossert’s (1998) concept of ‘decision space’, we explore the experiences of local commissioners as they took on their new responsibilities. We interviewed commissioning staff from all of the CCGs in two regional health care ‘economies’, exploring their perceptions of autonomy and their experiences over time. We found significant early enthusiasm for, and perceptions of, increased autonomy tempered in the vertical dimension by increasingly onerous and prescriptive monitoring regimes, and in the horizontal dimension by the proliferation of overlapping networks, inter-organisational groups and relationships. We propose that whatever the balance between central and local control that is adopted, complex public services require some sort of meso-level oversight from organisations able to ‘hold the ring’ between competing interests and to take a regional view of the needs of the local health system. This suggests that local organisational autonomy in such services will always be constrained.
AB - The optimal balance between central governmental authority and the degree of autonomy of local public bodies is an enduring issue in public policy. The UK National Health Service is no exception, with NHS history, in part at least, a history of repeated cycles of centralisation and decentralisation of decision making power. Most recently, a significant reorganisation of the NHS in 2102-13 was built around the creation of new and supposedly more autonomous commissioning organisations (Clinical Commissioning Groups – CCGs). Using Bossert’s (1998) concept of ‘decision space’, we explore the experiences of local commissioners as they took on their new responsibilities. We interviewed commissioning staff from all of the CCGs in two regional health care ‘economies’, exploring their perceptions of autonomy and their experiences over time. We found significant early enthusiasm for, and perceptions of, increased autonomy tempered in the vertical dimension by increasingly onerous and prescriptive monitoring regimes, and in the horizontal dimension by the proliferation of overlapping networks, inter-organisational groups and relationships. We propose that whatever the balance between central and local control that is adopted, complex public services require some sort of meso-level oversight from organisations able to ‘hold the ring’ between competing interests and to take a regional view of the needs of the local health system. This suggests that local organisational autonomy in such services will always be constrained.
KW - NHS
KW - decentralisation
KW - autonomy
KW - decision space
KW - Clinical Commissioning Groups
U2 - 10.1017/S0047279417000587
DO - 10.1017/S0047279417000587
M3 - Article
SN - 0047-2794
JO - Journal of Social Policy
JF - Journal of Social Policy
ER -