The Growing ‘Blurred Lines' of Health Care Provision in the English NHS

The growing ‘blurred lines’ of health care provision in the English NHS

With the advent of the 2012 Health and Social Care Act, marketization policies with an emphasis on both competition and choice have been pushed into the NHS limelight and there has been intense debate about whether or not the English NHS will be subjected to privatisation as a result of restrictions being lifted on commissioners. Under the reforms, commissioning of services has moved from managers to clinicians operating in Clinical Commissioning Groups (CCGs), who have the power and freedom to pursue provision from a large array of different providers, public, private and third-sector. This has lead to public debate about the use of non-public sector provision in the NHS and how the commissioners will choose to utilize the opportunities that they have in their new roles.

This paper will provide analysis and findings from a comparative ethnography, which follows the commissioning processes in two CCGs. This ethnography involves interviews with key informants and observation of committee meetings. Throughout two different services, mental health and elective surgery, with different histories of private provider involvement, have been traced and examined. The analysis looks at the commissioning process and how important the type of provider is to commissioners in their decision-making. Preliminary findings suggest that commissioners’ decisions are shaped by other influences that are more important than the type of provider, with commissioners pursuing a stance that can be described as being essentially pragmatic.