On Penalties and the Patient's Charter
Centralism v De-Centralised Governance in the NHS
Bibliographic Data
| ID | 2252017 |
|---|---|
| Authors | David Hughes (0000-0002-7631-7763, Swansea University), Lesley Griffiths (Swansea University) |
| Year | 1999 |
| Volume | 21 |
| Issue | 1 |
| Pages | 71-94 |
| Publication date | 1999-01-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Sociology of Health & Illness (JOURNAL) |
| Journal identifiers | ISSN: 0141-9889 • E-ISSN: 1467-9566 |
| Publisher | Wiley (PUBLISHER • GB) |
| DOI | 10.1111/1467-9566.t01-1-00143 |
| OpenAlex | W2076111315 |
| Language | EN |
| Citations received | 16 |
A paradox of the 1991 British NHS reforms is that increased central control over policy and strategy goes hand in hand with greater operational de-centralisation. Some commentators argue that market structures are leading to a dispersal of power, with local purchasers and providers assuming greater responsibility for the governance of their own relationships. Drawing inter alia on the Foucauldian concept of 'governmentality', they contend that 'action at a distance' or 'steering at a distance' is supplanting traditional bureaucratic regulation. Health authorities use contracts as a mechanism to constrain providers to deliver targets set by Government. We draw on a recent qualitative study of the NHS in Wales to examine the use of penalty clauses to enforce Patient's Charter guarantees for waiting times. This mechanism, which appears to govern the purchaser/provider relationship from within, turns out to be significantly constrained by continuing central direction. Moreover, informal resistance strategies, similar to those used in the past to counter bureaucratic regulation, operate to limit the impact of de-centralised contractual governance
Bureaucracy · Business · Centralisation · Centralized government · Charter · Corporate governance · Distrust · Economics · Government (linguistics · Governmentality · Law and economics · Market economy · Political science · Power (physics · Finance · Health Services Management and Policy · Healthcare innovation and challenges · Healthcare Systems and Challenges · Law · Public Administration
‘Real-world’ priority setting for service improvement in English primary care
Governmentality and risk
Making health services management research critical
The Local and the National in Community Care
A history of the intermediate tier in the English NHS
Governing beyond the Centre
Horizontal or Vertical Support
Someone's rooting for you
Talking contracts and taking care
The privatisation of Medicare and the National Health Service, and the global marketisation of healthcare systems
Contracts in the English NHS
The demise of repetitive strain injury in sceptical governing rationalities of workplace managers
Comparing professions through actor-centred governance
Going public
Some of our concepts are missing
Making connections
| Unique citing works | 16 |
|---|---|
| Citations per year | 0,62 |
| Citation span | 2000 - 2024 (25) |
| Citation velocity | recent |
| Highly cited | No |
| Citation types | Neutral: 16 |