scholarly journals Guardians of public interest: the expectation and experience of non-executive directors in National Health Service commissioning boards in England

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Joy Tweed ◽  
Louise M. Wallace
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Public Interest ◽  
Open Systems ◽  
Executive Directors ◽  
Goal Model ◽  
Content Type ◽  
The Public ◽  
Systems Model

PurposeThe purpose of the study is to examine how Non-Executive Directors (NEDs) in the English National Health Service (NHS) commissioning bodies experienced their role and contribution to governance.Design/methodology/approachSemi-structured interviews were conducted with a purposive sample of 31 NEDs of Primary Care Trusts (PCTs) and 8 Clinical Commissioning Group (CCG) NEDs. Framework analysis was applied using a conceptualisation of governance developed by Newman, which has four models of governance: the hierarchy, self-governance, open systems and rational goal model.FindingsNEDs saw themselves as guardians of the public interest. NEDs’ power is a product of the explicit levers set out in the constitution of the board, but also how they choose to use their knowledge and expertise to influence decisions for, as they see it, the public good. They contribute to governance by holding to account executive and professional colleagues, acting largely within the rational goal model. CCG NEDs felt less powerful than in those in PCTs, operating largely in conformance and representational roles, even though government policy appears to be moving towards a more networked, open systems model.Originality/valueThis is the first in-depth study of NEDs in English NHS local commissioning bodies. It is of value in helping to inform how the NED role could be enhanced to make a wider contribution to healthcare leadership as new systems are established in the UK and beyond.

Accountability for Rationing — Theory into Practice

2005 ◽  
Vol 33 (4) ◽  
pp. 660-668 ◽  
Author(s):  
Christopher Newdick
Keyword(s):  
Health Care ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Health Care Systems ◽  
The Public ◽  
Modern Health Care ◽  
Concept Of Health ◽  
Care Systems ◽  
Health Need

Most now recognize the inevitability of rationing in modern health care systems. The elastic nature of the concept of “health need,” our natural human sympathy for those in distress, the increased range of conditions for which treatment is available, the “greying” of the population; all expand demand for care in ways that exceed the supply of resources to provide it. UK governments, however, have found this truth difficult to present and have not encouraged open and candid public debate about choices in health care. Indeed, successive governments have presented the opposite view, that “if you are ill or injured there will be a national health service there to help; and access to it will be based on need and need alone.” And they have been rightly criticized for misleading the public and then blaming clinical and managerial staffin the National Health Service (NHS) when expectations have been disappointed.

scholarly journals Decentralization in the Public Sector

2003 ◽  
Vol 57 (2) ◽  
pp. 354-380 ◽  
Author(s):  
James Arrowsmith ◽  
Keith Sisson
Keyword(s):  
National Health Service ◽  
Public Sector ◽  
Health Service ◽  
International Development ◽  
National Health ◽  
Working Time ◽  
Environmental Constraints ◽  
Paradigm Case ◽  
The Public

Summary Decentralization has been an important international development in large organizations, including those in the public sector, in recent years. The introduction of self-governing trusts in the U.K. National Health Service in the early 1990s serves as a paradigm case of public sector decentralization, managerialism and marketization. Local managers were able to develop their own employment arrangements in order to improve the recruitment, retention and deployment of labour. This article finds that pay initiatives were subverted by environmental constraints but change proceeded in the organization of working time. The findings have implications beyond the U.K. and health service context, notably the conceptual relevance of the “firm-in-sector” framework and the policy limits and potential of decentralization.

scholarly journals Newly professionalised physiotherapists: symbolic or substantive change?

2019 ◽  
Vol 42 (2) ◽  
pp. 300-314
Author(s):  
Pauline Anderson ◽  
Chris Warhurst
Keyword(s):  
Qualitative Research ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Design Methodology ◽  
Content Type ◽  
Formal Classification ◽  
Mixed Outcomes

Purpose There is renewed interest in the professions as a range of occupations pursue professionalisation projects. The purpose of this paper is turn analysis to an important omission in current research – the skills deployed in the work of these professions. Such research is necessary because skills determine the formal classification of occupations as a profession. Design/methodology/approach Drawing on qualitative research, this paper explores the deployment of skills in work of one newly professionalised occupation in the UK’s National Health Service – physiotherapists. Findings The findings point to a disconnect between how this occupation has become a profession (the skills to get the job, and related political manoeuvring by representative bodies) and the mixed outcomes for their skills deployment (the skills to do the job) in work as a profession. Originality/value The paper provides missing empirical understanding of change for this new profession, and new conceptualisation of that change as both symbolic and substantive, with a “double hybridity” around occupational control and skill deployment for physiotherapists as a profession.

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