scholarly journals Doing More with Less in Health Care: Findings from a Multi-Method Study of Decommissioning in the English National Health Service

2017 ◽  
Vol 47 (3) ◽  
pp. 543-564 ◽  
Author(s):  
JENNY HARLOCK ◽  
IESTYN WILLIAMS ◽  
GLENN ROBERT ◽  
KELLY HALL ◽  
RUSSELL MANNION ◽  
...  
Keyword(s):  
Health Care ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Online Survey ◽  
Local Context ◽  
National Study ◽  
Local Health ◽  
English National Health ◽  
English National Health Service

AbstractIn the context of an austere financial climate, local health care budget holders are increasingly expected to make and enact decisions to decommission (reduce or stop providing) services. However, little is currently known about the experiences of those seeking to decommission. This paper presents the first national study of decommissioning in the English National Health Service drawing on multiple methods, including: an interview-based review of the contemporary policy landscape of health care decommissioning; a national online survey of commissioners of health care services responsible for managing and enacting budget allocation decisions locally; and illustrative vignettes provided by those who have led decommissioning activities. Findings are presented and discussed in relation to four themes: national-local relationships; organisational capacity and resources for decommissioning; the extent and nature of decommissioning; and intended outcomes of decommissioning. Whilst it is unlikely that local commissioners will be able to ‘successfully’ implement decommissioning decisions unless aspects of engagement, local context and outcomes are addressed, it remains unclear what ‘success’ looks like in terms of a decommissioning process.

scholarly journals “With Great Power Comes Great Responsibility”: Democracy, the Secretary of State for Health and Blame Shifting Within the English National Health Service

2018 ◽  
Vol 48 (3) ◽  
pp. 461-481 ◽  
Author(s):  
David I Benbow
Keyword(s):  
Health Care ◽  
National Health Service ◽  
Health Service ◽  
Social Relations ◽  
National Health ◽  
Market Reforms ◽  
Democratic Deficit ◽  
The Government ◽  
English National Health ◽  
English National Health Service

The English National Health Service (NHS) has suffered from a democratic deficit since its inception. Democratic accountability was to be through ministers to Parliament, but ministerial control over and responsibility for the NHS were regarded as myths. Reorganizations and management and market reforms, in the neoliberal era, have centralized power within the NHS. However, successive governments have sought to reduce their responsibility for health care through institutional depoliticization, to shift blame, facilitated through legal changes. New Labour’s creation of the National Institute for Clinical Excellence (NICE) and Monitor were somewhat successful in reducing ministerial culpability regarding health technology regulation and foundation trusts, respectively. The Conservative-Liberal Democrat coalition created NHS England to reduce ministerial culpability for health care more generally. This is pertinent as the NHS is currently being undermined by inadequate funding and privatization. However, the public has not shifted from blaming the government to blaming NHS England. This indicates limits to the capacity of law to legitimize changes to social relations. While market reforms were justified on the basis of empowering patients, I argue that addressing the democratic deficit is a preferable means of achieving this goal.

scholarly journals The Value of Data: Applying a Public Value Model to the English National Health Service

10.2196/15816 ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. e15816
Author(s):  
James Wilson ◽  
Daniel Herron ◽  
Parashkev Nachev ◽  
Nick McNally ◽  
Bryan Williams ◽  
...  
Keyword(s):  
Health Care ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Health Care Systems ◽  
Value Theory ◽  
Health Data ◽  
Public Value ◽  
English National Health ◽  
English National Health Service

Research and innovation in biomedicine and health care increasingly depend on electronic data. The emergence of data-driven technologies and associated digital transformations has focused attention on the value of such data. Despite the broad consensus of the value of health data, there is less consensus on the basis for that value; thus, the nature and extent of health data value remain unclear. Much of the existing literature presupposes that the value of data is to be understood primarily in financial terms, and assumes that a single financial value can be assigned. We here argue that the value of a dataset is instead relational; that is, the value depends on who wants to use it and for what purposes. Moreover, data are valued for both nonfinancial and financial reasons. Thus, it may be more accurate to discuss the values (plural) of a dataset rather than the singular value. This plurality of values opens up an important set of questions about how health data should be valued for the purposes of public policy. We argue that public value models provide a useful approach in this regard. According to public value theory, public value is created, or captured, to the extent that public sector institutions further their democratically established goals, and their impact on improving the lives of citizens. This article outlines how adopting such an approach might be operationalized within existing health care systems such as the English National Health Service, with particular focus on actionable conclusions.

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