Investigating the Governance of Autonomous Public Hospitals in England: Multi-Site Case Study of NHS Foundation Trusts

Allen, Pauline; Keen, Justin; Wright, John; Dempster, Paul; Townsend, Jean; Hutchings, Andrew; Street, Andrew; Verzulli, Rossella

doi:10.1258/jhsrp.2011.011046

Cited by 41 publications

(51 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This process was accelerated after 2003, with the introduction of a new organisational form: Foundation Trusts (FTs). Conforming to the model of corporatisation described earlier (Lindlbauer et al 2015), FTs remain part of the NHS (and hence in public ownership), but are re-designated as public benefit corporations with significantly more formal autonomy than the other NHS trusts (Allen et al 2012). …”

Section: Research Contextmentioning

confidence: 99%

“…Applying trusts need to show that they have a number of controls, checks and assurances processes and procedures in place, ranging from trust financial viability to effective quality and safety checks. Most importantly, authorisation to become an FT is 20 conditional on performance, this initially being branded as a form of 'earned autonomy' (Allen et al 2012). The independent regulator, Monitor (responsible for providing authorisation), concentrates on the efficiency of organisational processes and the fitness-for-purpose of the governance arrangements.…”

Section: Research Contextmentioning

confidence: 99%

See 1 more Smart Citation

Corporatisation and the Emergence of (Under-Managered) Managed Organisations: The Case of English Public Hospitals

Kirkpatrick

Altanlar

Veronesi

2017

Organization Studies

View full text Add to dashboard Cite

An enduring feature of new public management (NPM) in many countries has been the move to create more autonomous, 'complete' organisations such as universities, hospitals and social service agencies. Often referred to as 'corporatisation', this process is assumed to be leading to the emergence of new organisational forms with dedicated management functions and a greater focus on strategy. However, these assumptions remain largely untested and rely heavily on 'technical' accounts of organisational restructuring, ignoring the potential influence of institutional pressures and internal political dynamics. In this paper, we address this concern focusing on the case of acute care public hospitals that have undergone corporatisation (to become Foundation Trusts) in the English National Health Service. Using administrative data spanning six years (2007)(2008)(2009)(2010)(2011)(2012), the analysis shows that corporatisation is having mixed effects.While it is associated with a shift in the focus of managers to strategic concerns, it has not led to an expansion of management functions overall. Both tendencies are found to be mediated by institutional pressures, in the form of media scrutiny, and, indirectly, by the involvement of clinical professions in management. These results advance ongoing debates about the emergence of new organisational forms in the public sector, highlighting the limitations of technical accounts of change and raising the possibility that corporatisation is leading to organisations that are both more managed and undermanagered at the same time. KeywordsCorporatisation, contingency theory, institutional theory, management.1 'Corporatisation and the emergence of (under-managered) managed organisations: the case of English public hospitals' Abstract An enduring feature of new public management (NPM) in many countries has been the move to create more autonomous, 'complete' organisations such as universities, hospitals and social service agencies. Often referred to as 'corporatisation', this process is assumed to be leading to the emergence of new organisational forms with dedicated management functions and a greater focus on strategy. However, these assumptions remain largely untested and rely heavily on 'technical' accounts of organisational restructuring, ignoring the potential influence of institutional pressures and internal political dynamics. In this paper, we address this concern focusing on the case of acute care public hospitals that have undergone corporatisation (to become Foundation Trusts) in the English National Health Service. Using administrative data spanning six years (2007)(2008)(2009)(2010)(2011)(2012), the analysis shows that corporatisation is having mixed effects.While it is associated with a shift in the focus of managers to strategic concerns, it has not led to an expansion of management functions overall. Both tendencies are found to be mediated by institutional pressures, in the form of media scrutiny, and, indirectly, by the involvement of clinical professions in m...

show abstract

Section: Research Contextmentioning

confidence: 99%

Section: Research Contextmentioning

confidence: 99%

Corporatisation and the Emergence of (Under-Managered) Managed Organisations: The Case of English Public Hospitals

Kirkpatrick

Altanlar

Veronesi

2017

Organization Studies

View full text Add to dashboard Cite

show abstract

“…Estudos internacionais vêm discutindo os impactos da autonomia em estabelecimentos públicos, principalmente no âmbito hospitalar 6,7 , em que também no Brasil identifica-se a maior prevalência de autonomia pública. Para Paim 8 , baixa autonomia financeira na administração direta da saúde é uma questão central no SUS, e ainda hoje pode atingir inclusive órgãos gestores, como secretarias de saúde.…”

Section: Discussionunclassified

Autonomia financeira em estabelecimentos públicos e privados de saúde no Brasil

et al. 2014

View full text Add to dashboard Cite

Autonomia financeira é um diferencial positivo na gestão pública, sendo referida na Pesquisa de Assistência Médico-Sanitária (2009) por 3,9% dos 52.055 estabelecimentos públicos de saúde. Foi mais frequente em estabelecimentos públicos com internação (17,8% do total), da administração estadual (26,3%) e da Região Sul (6,6%) e, em geral, era parcial (apenas para algumas áreas, como despesas emergenciais, material de consumo e permanentes, serviços de terceiros e pessoal). Quanto à natureza jurídica, 83,7% dos 2.011 estabelecimentos públicos que referiram alguma autonomia são da administração direta. A atribuição de autonomia financeira a estabelecimentos públicos de saúde parece ser definição política local, que não se prende necessariamente a mudanças de natureza jurídica. Ainda assim, confirmou-se um espectro crescente de maior autonomia segundo natureza jurídica, em que estabelecimentos da administração direta da saúde são os menos autônomos e as sociedades empresariais as mais autônomas; 85,8% dos 45.394 estabelecimentos privados tinham alguma autonomia financeira.

show abstract

“…Allen et al (2012) studied the development and governance of NHS Foundation Trusts, finding that they had used their increased vertical autonomy to introduce more business-like practices, with regulators only intervening when problems were reported. However, national-level targets continued to have a significant impact on their work, and they were also constrained horizontally by the need to maintain good relationships with local organisations.…”

Section: Autonomy and Decision Space In The Nhsmentioning

confidence: 99%

“…However, national-level targets continued to have a significant impact on their work, and they were also constrained horizontally by the need to maintain good relationships with local organisations. It was intended that Foundation Trusts would manifest additional local accountability, with governance by local 'members', but this has proved problematic to realise in practice (Allen et al, 2012). Exworthy et al (2011) studied Foundation Trusts' willingness and ability to exercise autonomy at three levels: macro; meso; and micro, and found that, whilst they had theoretically gained autonomy from central control, in practice, new forms of economic regulation had partially replaced the previous NHS hierarchy, with Foundation Trusts held to account by Monitor (a health care provider financial regulator, since April 2016 known as NHS Improvement) through a variety of performance and assessment mechanisms.…”

Section: Autonomy and Decision Space In The Nhsmentioning

confidence: 99%

Being Autonomous and Having Space in which to Act: Commissioning in the ‘New NHS’ in England

Checkland¹,

Dam²,

Hammond³

et al. 2017

J. Soc. Pol.

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Investigating the Governance of Autonomous Public Hospitals in England: Multi-Site Case Study of NHS Foundation Trusts

Cited by 41 publications

References 8 publications

Corporatisation and the Emergence of (Under-Managered) Managed Organisations: The Case of English Public Hospitals

Corporatisation and the Emergence of (Under-Managered) Managed Organisations: The Case of English Public Hospitals

Autonomia financeira em estabelecimentos públicos e privados de saúde no Brasil

Being Autonomous and Having Space in which to Act: Commissioning in the ‘New NHS’ in England

Contact Info

Product

Resources

About