Healthcare Providers in the English National Health Service

Abstract

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.

Public, Private or Neither? Analysing the publicness of health care social enterprises

“…NHS spin outs, and therefore a particular type of public service delivery, the findings do have important implications for debates around publicness. To date, publicness theory has been based on binary distinctions between the public and private (Allen et al, 2011). Within the context of public service marketization (Eikenberry and Kluvert, 2004) leading to a more prominent role of the third sector in the delivery of public services, we argue that 'publicness' debates need to evolve.…”

“…They were less comfortable in being seen as exhibiting private sector characteristics although it was recognised that this could provide a route to additional funding and resources. Rather than aligning with a particular sector, these organisations were described as having embraced elements of each, adding further weight to the conclusion that social enterprises are very much 'hybrid' organisations (Allen et al, 2011;Billis, 2010;Battilana and Lee, 2014), located at the intersection between the third, public and private sectors.…”

“…Therefore, social enterprise spin outs are still significantly public, especially in relation to their funding which for many comes wholly from public sector contracts making them especially vulnerable to policy and legislation changes. In addition, as providers of public healthcare, they remain bound by political control and are subject to government decisions over their participation in the NHS (Allen et al, 2011). Furthermore, whilst they have the economic authority to change staff terms and conditions, the danger in doing this is that staff may leave to go back to the public sector.…”

“…In healthcare, Allen et al (2011) argue that the boundaries between public and private providers of welfare services have become blurred. They looked at a range of healthcare providers in England and found that rather than belonging to categories of public, private or third sector, they are instead hybrids.…”

Publicness, Organisational Characteristics and Performance

“…A simple dichotomy of public or private ownership is no longer adequate for defining hospitals in England (Allen et al, 2011 This organisational characteristic can be described as 'diffusion of ownership', and it can be operationalized in terms of the number of owners the organization has. Thus in the private sector, many hospitals are independently owned by an individual or partnership, whilst others are run by big corporations with large numbers of shareholders.…”