INTERROGATING INSTITUTIONAL CHANGE: ACTORS' ATTITUDES TO COMPETITION AND COOPERATION IN COMMISSIONING HEALTH SERVICES IN ENGLAND |
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| Authors: | DOROTA OSIPOVIČ PAULINE ALLEN ELIZABETH SHEPHERD ANNA COLEMAN NEIL PERKINS LORRAINE WILLIAMS MARIE SANDERSON KATHERINE CHECKLAND |
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| Affiliation: | 1. Dorota Osipovi?, Pauline Allen, Elizabeth Shepherd, Lorraine Williams and Marie Sanderson are at the Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, UK;2. Anna Coleman, Neil Perkins and Katherine Checkland are at the Centre for Primary Care, University of Manchester, UK |
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| Abstract: | 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. |
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