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Increasing autonomy in publically owned services: The case of community health services in England

Ailsa Cameron (School for Policy Studies, University of Bristol, Bristol, UK)
Pauline Allen (HSRU, London School of Hygiene and Tropical Medicine, London, UK)
Lorraine Williams (Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK)
Mary Alison Durand (Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK)
Will Bartlett (London School of Economics, London, UK)
Virginie Perotin (Leeds University Business School, University of Leeds, Leeds, UK)
Andrew Hutchings (Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London, UK)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 21 September 2015

375

Abstract

Purpose

The purpose of this paper is to explore government efforts to enhance the autonomy of community health services (CHS) in England through the creation of Foundation Trusts status. It considers why some CHS elected to become nascent Community Foundation Trusts (CFTs) while others had not and what advantages they thought increased levels of autonomy offered.

Design/methodology/approach

Data are drawn from the evaluation of the Department of Health’s CFT pilot programme. Participants were purposively selected from pilot sites, as well as from comparator non-pilot organisations. A total of 44 staff from 14 organisations were interviewed.

Findings

The data reveals that regardless of the different pathways that organisations were on, they all shared the same goal, a desire for greater autonomy, but specifically within the NHS. Additionally, irrespective of their organisational form most organisations were considering an almost identical set of initiatives as a means to improve service delivery and productivity.

Research limitations/implications

Despite the expectations of policy makers no CFTs were established during the course of the study, so it is not possible to find out what the effect of such changes were. Nevertheless, the authors were able to investigate the attitudes of all the providers of CHS to the plans to increase their managerial autonomy, whether simply by separating from PCTs or by becoming CFTs.

Originality/value

As no CFTs have yet been formed, this study provides the only evidence to date about increasing autonomy for CHS in England.

Keywords

Acknowledgements

The authors would like to acknowledge the efforts of Simon Turner and John Wright who undertook the first 13 interviews. This paper reports research from an independent report commissioned and funded by the Policy Research Programme in the Department of Health. The views expressed are not necessarily those of the Department.

Citation

Cameron, A., Allen, P., Williams, L., Durand, M.A., Bartlett, W., Perotin, V. and Hutchings, A. (2015), "Increasing autonomy in publically owned services: The case of community health services in England", Journal of Health Organization and Management, Vol. 29 No. 6, pp. 778-794. https://doi.org/10.1108/JHOM-06-2014-0098

Publisher

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Emerald Group Publishing Limited

Copyright © 2015, Emerald Group Publishing Limited

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