DECENTRALIZING HEALTH SERVICES IN THE UK: A NEW CONCEPTUAL FRAMEWORK |
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| Authors: | STEPHEN PECKHAM MARK EXWORTHY MARTIN POWELL IAN GREENER |
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| Affiliation: | 1
Stephen Peckham is Senior Lecturer in Health Services Delivery and Organisation at the London School of Hygiene and Tropical Medicine. 2Mark Exworthy is Reader in Public Management at Royal Holloway University of London. 3Martin Powell is Professor of Health and Social Policy, the Health Services Management Centre, University of Birmingham. 4Ian Greener is Reader in the School of Applied Social Sciences, University of Durham. |
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| Abstract: | Decentralization is a central plank of current government health policy. However, it is possible to discern both centralist and decentralist movements in the UK. This paper examines existing frameworks of decentralization in relation to identifying whether policy is decentralist or not and identifies a number of problems that limit their value. Key problems relate to the way decentralization is conceptualized and defined. Existing frameworks are also highly contextualized and are therefore of limited value when applied in different contexts. The paper then presents a new framework which, it is argued, provides a more useful way of examining centralization and decentralization by providing a way of categorizing policies and actions and avoids the problems of being contextually constrained. The paper ends with a discussion of how the framework can be applied in a health context and shows how this framework helps avoid the problems found in previous discussions of decentralization. |
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