Governance for health and wellbeing in the English NHS

Marks, L; Cave, S; Hunter, D; Mason, J; Peckham, S; Wallace, A; (2011) Governance for health and wellbeing in the English NHS. Journal of health services research & policy, 16. pp. 14-21. ISSN 1355-8196 DOI:

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Objectives: Shifting the focus of health-care systems towards prevention has proved difficult to achieve. Governance structures are complex, incentives may conflict and there are many competing priorities. We explored the influence of governance and incentive arrangements on commissioning for health and wellbeing in the English National Health Service (NHS) and the governance paradoxes which emerge. Methods: Qualitative and quantitative methods were employed. We carried out one national and two regional focus groups; a national online survey of primary care trusts (PCTs); and 99 semi-structured interviews in 10 purposively selected case study sites across England. Interviewees included decision-makers in PCTs, practice-based commissioners, Chairs of Local Involvement Networks (LINks) and of Overview and Scrutiny committees (OSCs) and Voluntary and Community Sector (VCS) members of local health and wellbeing partnerships. Results: Case study sites differed in the extent to which they reflected a public health ethos throughout the commissioning cycle, incentivized preventive services through contractual flexibilities or prioritized investment in health and wellbeing. Practice-based commissioners were tangentially involved in the commissioning cycle, public health partnerships or local health needs assessment. While commissioning for health and wellbeing involves working through partnerships, performance management regimes favoured single organizational success. Preventive services were considered at increased risk in times of financial stringency. Conclusions: As the NHS in England undergoes further reorganization, it is important to ensure that a systematic, strategic and population-based approach to commissioning is not lost. Governance and incentive arrangements should be critically assessed for their impact on population health and wellbeing. Journal of Health Services Research & Policy Vol 16 Suppl 1, 2011-14-21 (C) The Royal Society of Medicine Press Ltd 2011

Item Type: Article
Keywords: Decision Making, Organizational, Delivery of Health Care, organization & administration, England, Focus Groups, Governing Board, Health Policy, Humans, Motivation, Organizational Case Studies, Preventive Medicine, organization & administration, Primary Health Care, organization & administration, Qualitative Research, Quality of Life, State Medicine, organization & administration
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
PubMed ID: 21460345
Web of Science ID: 290419100004


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