Abstract:This article examines the impact of the Health and Social Care Act 2012 on the regulation of competition in the English National Health Service (NHS), by focussing on the change it marked from a system of sector-specific regulation to one which is clearly based in competition law. It has been suggested that the Act and its associated reforms would significantly alter accountability in the NHS, and would change decisions from the remit of public policy to that of the law. To assess the impact the Act has had in… Show more
“…Similarly, during the fieldwork some participants began to note a ‘watering down’ of the imperative to increase the levels of tendering and competition. Arguably, a change in the tone of policy discourse could be noted in the aftermath of the rejection of the proposed merger of two hospitals in Dorset in October 2013, which forced Monitor to reassess the way the merger review process was being handled by the competition authorities (Competition Commission ; see also Sanderson et al ). This merger rejection raised concerns among many that the competition regulations were detrimental to attempts to produce desirable reconfiguration of services.My understanding is that it's now less of a requirement than it used to be … you have to show … value, which doesn't necessarily mean that you have to put everything out to competition.…”
Section: Understanding Of Formal Rulesmentioning
confidence: 99%
“…From April 2016 Monitor is part of NHS Improvement. 2 For more details on the impact of the regulatory regime following the HSCA 2012 seeSanderson et al (2016).3 In our conceptual framework private providers represent one of the signs of structural hybridity of the NHS. As such, the detailed analysis of their views falls outside the scope of this article.…”
Since the beginning of the 1990s the public healthcare system in England has been subject to reforms. This has resulted in a structurally hybrid system of public service with elements of the market. Utilizing a theory of new institutionalism, this article explores National Health Service (NHS) managers' views on competition and cooperation as mechanisms for commissioning health services. We interrogate the extent of institutional change in the NHS by examining managers' understanding of the formal rules, normative positions and frameworks for action under the regime of the Health and Social Care Act 2012. Interviews with managers showed an overall preference for cooperative approaches, but also evidence of marketization in the normative outlook and actions. This suggests that hybridity in the NHS has already spread from structure and rules to other institutional pillars. The study showed that managers were adept at navigating the complex policy environment despite its inherent contradictions.
“…Similarly, during the fieldwork some participants began to note a ‘watering down’ of the imperative to increase the levels of tendering and competition. Arguably, a change in the tone of policy discourse could be noted in the aftermath of the rejection of the proposed merger of two hospitals in Dorset in October 2013, which forced Monitor to reassess the way the merger review process was being handled by the competition authorities (Competition Commission ; see also Sanderson et al ). This merger rejection raised concerns among many that the competition regulations were detrimental to attempts to produce desirable reconfiguration of services.My understanding is that it's now less of a requirement than it used to be … you have to show … value, which doesn't necessarily mean that you have to put everything out to competition.…”
Section: Understanding Of Formal Rulesmentioning
confidence: 99%
“…From April 2016 Monitor is part of NHS Improvement. 2 For more details on the impact of the regulatory regime following the HSCA 2012 seeSanderson et al (2016).3 In our conceptual framework private providers represent one of the signs of structural hybridity of the NHS. As such, the detailed analysis of their views falls outside the scope of this article.…”
Since the beginning of the 1990s the public healthcare system in England has been subject to reforms. This has resulted in a structurally hybrid system of public service with elements of the market. Utilizing a theory of new institutionalism, this article explores National Health Service (NHS) managers' views on competition and cooperation as mechanisms for commissioning health services. We interrogate the extent of institutional change in the NHS by examining managers' understanding of the formal rules, normative positions and frameworks for action under the regime of the Health and Social Care Act 2012. Interviews with managers showed an overall preference for cooperative approaches, but also evidence of marketization in the normative outlook and actions. This suggests that hybridity in the NHS has already spread from structure and rules to other institutional pillars. The study showed that managers were adept at navigating the complex policy environment despite its inherent contradictions.
“…In our previous analysis of regulatory activity conducted early in the HSCA 2012 regime we found limited evidence for juridification (Sanderson et al, 2017). We argued that although the regulatory structures put in place by the HSCA 2012 had potential to strengthen the enforcement of competition in the NHS, in practice the extent of juridification was limited due to the development of systems within the NHS to manage and resolve issues internally where possible (Sanderson et al, 2017).…”
Since 1990, market mechanisms have occurred in the predominantly hierarchical National Health Service (NHS). The Health and Social Care Act 2012 led to concerns that market principles had been irrevocably embedded in the NHS and that the regulators would acquire unwarranted power compared with politicians (known as ‘juridification’). To assess this concern, we analysed regulatory activity in the period from 2015 to 2018. We explored how economic regulation of the NHS had changed in light of the policy turn back to hierarchy in 2014 and the changes in the legislative framework under Public Contracts Regulations 2015. We found the continuing dominance of hierarchical modes of control was reflected in the relative dominance and behaviour of the sector economic regulator. But there had also been a limited degree of juridification involving the courts. Generally, the regulatory decisions were consistent with the 2014 policy shift away from market principles and with the enduring role of hierarchy in the NHS, but the existing legislative regime did allow the incursion of pro market regulatory decision making, and instances of such decisions were identified.
“…Crucially, aspects of these inter-organizational collaborations and partnerships may exist in tension with existing competition regulations (Sanderson, Allen, and Osipovic 2017). In one case in 2017, the Competition and Markets Authority approved a merger between two Foundation Trust hospitals, despite it having recognized an adverse effect on market competition.…”
Section: Nhs England: Autonomy Accountability and Meta-governancementioning
Meta-governance involves orchestrating the 'rules of the game' in public management. Arm's-length bodies are particularly important vehicles for this. We consider the case of an arm's-length body (NHS England) created to oversee the English NHS' day-to-day operation, and remove 'political interference'. Although mandated by the Department of Health it has increasingly operated as policy-maker, developing policies in tension with existing legislation, while Ministers have faded from public-facing accounts of service operation. This suggests NHS England operates as a meta-governor, insulating government whilst pursuing its own agenda, and raises crucial questions about governmental accountability whilst simultaneously making answers harder to obtain.
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