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This chapter explains how fundamental organisational change in the UK National Health Service (NHS) is being effected by new practices of digitised information gathering and use. It analyses the taken-for-granted IT infrastructures that lie behind digitisation and considers the relationship between digitisation and big data.

Qualitative research methods including discourse analysis, ethnography of software and key informant interviews were used. Actor-network theories, as developed by Science and technology Studies (STS) researchers were used to inform the research questions, data gathering and analysis. The chapter focuses on the aftermath of legislation to change the organisation of the NHS.

The chapter shows the benefits of qualitative research into specific manifestations information technology. It explains how apparently ‘objective’ and ‘neutral’ quantitative data gathering and analysis is mediated by complex software practices. It considers the political power of claims that data is neutral.

The chapter provides insight into a specific case of healthcare data and. It makes explicit the role of politics and the State in digitisation and shows how STS approaches can be used to understand political and technological practice.

What is our unit of analysis and by implication what are the boundaries of our cases? This is a question we grapple with at the start of every new project. We observe that case studies are often referred to in an unreflective manner and are often conflated with geographical location. Neat units of analysis and clearly bounded cases usually do not reflect the messiness encountered during qualitative fieldwork. Others have puzzled over these questions. We briefly discuss work to problematise the use of households as units of analysis in the context of apartheid South Africa and then consider work of other anthropologists engaged in multi-site ethnography. We have found the notion of ‘following’ chains, paths and threads across sites to be particularly insightful.

We present two examples from our work studying commissioning in the English National Health Service (NHS) to illustrate our struggles with case studies. The first is a study of Practice-based Commissioning groups and the second is a study of the early workings of Clinical Commissioning Groups. In both instances we show how ideas of what constituted our unit of analysis and the boundaries of our cases became less clear as our research progressed. We also discuss pressures we experienced to add more case studies to our projects. These examples illustrate the primacy for us of understanding interactions between place, local history and rapidly developing policy initiatives. Understanding cases in this way can be challenging in a context where research funders hold different views of what constitutes a case.

The goal of this contribution is to shed light on the benefits for research in health care coming from the use of administrative data, especially in terms of measuring hospitals’ outcomes. The main approaches to health outcome evaluation are reviewed and the possible improvements deriving from the use of administrative data are highlighted. Administrative data may be an essential element in the process of gathering to the public true rankings of health care organizations, reducing the degree of asymmetric information that typically arises in health care. Patients will be more aware of the best institutions, which will induce most of them to demand to be admitted in them, taking into account the costs associated with distance and with the severity of the illness. This in turn may ask for a reorganization of the sector, closing some organizations and expanding others, having as final goal to improve the health status of the population, without income barriers. This is one of the first attempts to provide an overview of the advantages that administrative data may gather in health care.

This chapter provides a historical contextualisation of health tracking and public health communication from the post-World War Two development of the welfare state, through the birth of neoliberalism, until today’s individualising practices of digital health tracking and quantification of bodies. Through an examination of these three phases of public health quantification of bodies, encompassing the socio-economic, cultural and political shifts since 1948, combined with the development and wide adoption of digital health and self-quantifying technologies, this chapter traces the changing landscape and the dramatic implications this has had for shifting who is responsible for maintaining ‘good’ health. This chapter illustrates how neoliberal free market principles have reigned over UK public health discourse for many decades, seeing health as no longer binary to illness, but as a practice of individual self-quantification and self-care. In turn, the chapter explores how the quantification and health tracking of bodies has become a dominant discourse in public health promotion, as well as individual citizenship and patient practices. This discourse still exists pervasively as we move into the digital society of the 2020s, through the Covid-19 pandemic and beyond; with public health strategies internationally promoting the use of digital health tools in our everyday, further positioning citizens as entrepreneurial subjects, adopting extensive technological measures in an attempt to measure and ‘optimise’ health, normalising the everyday quantification of bodies.

The National Health Service is key to Britain’s welfare state, and has been subject to repeated reform initiatives. Such reforms rarely “fix” the problems for which they are introduced, but evaluations have neglected the significance of local action. Reform implementation involves local translation of politically contextualized ideas into workable practice. I focus on implementation processes and the role of professions. Ethnographic data reveal local actors engaging with policy objectives to protect existing structures within the boundaries of official reform rhetoric. Actors employ multiple strategies to maintain existing systems. Rather than “failing,” policy is made through localized collaboration.

Purpose – The chapter aims to understand what kind of policy approach has been more successful in facilitating the involvement of patients and the public in the design and provision of health-care services at the local level and the explanatory factors justifying the implementation outcome.Methodology – By applying Richard Matland's ambiguity/conflict policy implementation model, the chapter analyses the impact of a number of policies introduced after 1997 in the English National Health Service that targeted final users and the local population in decision-making processes.Findings – The evidence shows that policies emphasising the importance of context-specific contingencies can be more effectively implemented when room for interpretation and discretion in selecting the appropriate means for involvement is given. In this way, the overall aims/purposes of health policies can be locally reshaped by allowing the adoption of flexible strategies within the implementation process.Practical implications – A strong leadership at the top of public sector organisations and, in particular, from the board of directors is needed to steer and facilitate a consensus oriented outcome in organisational decision-making processes that aim to incorporate the views and opinions of patients and the public.Social implications – Local initiatives in increasing participation, for specific purposes, are bound to be more successful than a general initiative, expecting comparatively uniform implementation.

This chapter contributes to the Public Value (PV) literature in relation to accounting by providing evidence on its content's operationalization through performance measurement. In particular, it establishes the link with Sustainable Development Goals (SDGs), which may work as guiding principles of a public organization’s action. Accordingly, organizations embedding SDGs include them in their strategic decisions and disclose them through performance measurement and narratives.

The SDGs' presence is explored in the PV of a sample of Italian health institutes through documentary analysis of their performance plans. The aim is to verify if and how SDGs are pursued and whether the COVID-19 pandemic has affected PV content.

Besides Goal No. 3 (Health), the PV content of the investigated institutes contains various SDGs. Before the pandemic, their PV was aligned with SDGs mainly related to prosperity, economic growth and social inclusion. In the following period, the number of SDGs increased, introducing planet and environmental protection dimensions. No one explicitly mentions pursuing SDGs, revealing a non-institutionalized sensitivity of managers towards SDGs. The analysis distinguishes between ‘core’ SDGs, revealed mostly by traditional performance measures disclosing the achievement of institutes' mission, and ‘complementary’ SDGs, expressed mostly through narratives. This can derive from performance measurement, which employs the language of performativity, while the contribution to society is relegated in the narratives, making them less incisive.