Marks, I. and Cave, S. and Wallace, A. and Hunter, D. and Mason, J. and Peckham, S. (2011) Governance for health and wellbeing in the English NHS. Journal of Health Services Research and Policy, 16 (s1). pp. 14-21. ISSN 1355-8196.
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Objectives Shifting the focus of health-care systems towards prevention has proved difficult to achieve. Governance structures are complex, incentives may conflict and there are many competing priorities. We explored the influence of governance and incentive arrangements on commissioning for health and well-being in the English National Health Service (NHS) and the governance paradoxes which emerge. Methods Qualitative and quantitative methods were employed. We carried out one national and two regional focus groups; a national online survey of primary care trusts (PCTs); and 99 semi-structured interviews in 10 purposively selected case study sites across England. Interviewees included decision-makers in PCTs, practice-based commissioners, Chairs of Local Involvement Networks (LINks) and of Overview and Scrutiny committees (OSCs) and Voluntary and Community Sector (VCS) members of local health and wellbeing partnerships. Results Case study sites differed in the extent to which they reflected a public health ethos throughout the commissioning cycle, incentivized preventive services through contractual flexibilities or prioritized investment in health and wellbeing. Practice-based commissioners were tangentially involved in the commissioning cycle, public health partnerships or local health needs assessment. While commissioning for health and wellbeing involves working through partnerships, performance management regimes favoured single organizational success. Preventive services were considered at increased risk in times of financial stringency. Conclusions As the NHS in England undergoes further reorganization, it is important to ensure that a systematic, strategic and population-based approach to commissioning is not lost. Governance and incentive arrangements should be critically assessed for their impact on population health and wellbeing.
|Subjects:||H Social Sciences > HV Social pathology. Social and public welfare
J Political Science > JS Local government Municipal government
R Medicine > RA Public aspects of medicine
|Divisions:||Faculties > Social Sciences > School of Social Policy Sociology and Social Research > Centre for Health Services Studies|
|Depositing User:||Tony Rees|
|Date Deposited:||04 Jul 2012 13:17|
|Last Modified:||15 Feb 2013 12:16|
|Resource URI:||http://kar.kent.ac.uk/id/eprint/29785 (The current URI for this page, for reference purposes)|
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