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Agreeing the allocation of scarce resources in the English NHS: Ostrom, common pool resources and the role of the state

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  • Sanderson, Marie
  • Allen, Pauline
  • Moran, Valerie
  • McDermott, Imelda
  • Osipovic, Dorota

Abstract

A challenge facing health systems such as the English National Health Service (NHS), which operate in a context of diversity of provision and scarcity of financial resources, is how organisations engaged in the provision of services can be encouraged to adopt collective resource utilisation strategies to ensure limited resources are utilised in the interests of service users and, in the case of tax funded services, the general public. In this paper the authors apply Elinor Ostrom's work concerning communities' self-governance of common pool resources to the development of collective approaches to the utilisation of resources for the provision of health services. Focusing on the establishment of Sustainability and Transformation Partnerships (STPs) in the English NHS, and drawing on interviews with senior managers in English NHS purchaser and provider organisations, we use Ostrom's work as a frame to analyse STPs, as vehicles to agree and enact shared rules governing the allocation of financial resources, and the role of the state in relation to the development of this collective governance. While there was an unwillingness to use STPs to agree collective rules for resource allocation, we found that local actors were discussing and agreeing collective approaches regarding how resources should be utilised to deliver health services in order to make best use of scarce resources. State influence on the development of collective approaches to resource allocation through the STP was viewed by some as coercive, but also provided a necessary function to ensure accountability. Our analysis suggests Ostrom's notion of resource ‘appropriation’ should be extended to capture the nuances of resource utilisation in complex production chains, such as those involved in the delivery of health services where the extraction of funds is not an end in itself, but where the value of resources depends on how they are utilised.

Suggested Citation

  • Sanderson, Marie & Allen, Pauline & Moran, Valerie & McDermott, Imelda & Osipovic, Dorota, 2020. "Agreeing the allocation of scarce resources in the English NHS: Ostrom, common pool resources and the role of the state," Social Science & Medicine, Elsevier, vol. 250(C).
    • Handle: RePEc:eee:socmed:v:250:y:2020:i:c:s0277953620301076
    DOI: 10.1016/j.socscimed.2020.112888
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    References listed on IDEAS

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    1. Pennington, Mark, 2013. "Elinor Ostrom and the robust political economy of common-pool resources," Journal of Institutional Economics, Cambridge University Press, vol. 9(4), pages 449-468, December.
    2. Elinor Ostrom, 2010. "Beyond Markets and States: Polycentric Governance of Complex Economic Systems," American Economic Review, American Economic Association, vol. 100(3), pages 641-672, June.
    3. Hammond, Jonathan & Lorne, Colin & Coleman, Anna & Allen, Pauline & Mays, Nicholas & Dam, Rinita & Mason, Thomas & Checkland, Kath, 2017. "The spatial politics of place and health policy: Exploring Sustainability and Transformation Plans in the English NHS," Social Science & Medicine, Elsevier, vol. 190(C), pages 217-226.
    4. Amrita Chhachhi & Tim Forsyth & Craig Johnson, 2014. "Elinor Ostrom's Legacy: Governing the Commons and the Rational Choice Controversy," Development and Change, International Institute of Social Studies, vol. 45(5), pages 1093-1110, September.
    5. Doris Wiesmann & Johannes Jütting, 2000. "The emerging movement of community based health insurance in sub-Saharan Africa: Experiences and lessons learned," Africa Spectrum, Institute of African Affairs, GIGA German Institute of Global and Area Studies, Hamburg, vol. 35(2), pages 193-210.
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    1. David Bruce Matchar & Wei Xuan Lai & Ashish Kumar & John Pastor Ansah & Yeuk Fan Ng, 2023. "A Causal View of the Role and Potential Limitations of Capitation in Promoting Whole Health System Performance," IJERPH, MDPI, vol. 20(5), pages 1-13, March.

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