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Innovation and the English National Health Service: A qualitative study of the independent sector treatment centre programme


  • Turner, Simon
  • Allen, Pauline
  • Bartlett, Will
  • Pérotin, Virginie


Over the past two decades, an international trend of exposing public health services to different forms of economic organisation has emerged. In the English National Health Service (NHS), care is currently provided through a quasi-market including 'diverse' providers from the private and third sector. The predominant scheme through which private sector companies have been awarded NHS contracts is the Independent Sector Treatment Centre (ISTC) programme. ISTCs were designed to produce innovative models of service delivery for elective care and stimulate innovation among incumbent NHS providers. This paper investigates these claims using qualitative data on the impact of an ISTC upon a local health economy (LHE) composed of NHS organisations in England. Using the case of elective orthopaedic surgery, we conducted semi-structured interviews with senior managers from incumbent NHS providers and an ISTC in 2009. We show that ISTCs exhibit a different relationship with frontline clinicians because they counteract the power of professional communities associated with the NHS. This has positive and negative consequences for innovation. ISTCs have introduced new routines unencumbered by the extant norms of professional communities, but they appear to represent weaker learning environments and do not reproduce cooperation across organisational boundaries to the same extent as incumbent NHS providers.

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  • Turner, Simon & Allen, Pauline & Bartlett, Will & Pérotin, Virginie, 2011. "Innovation and the English National Health Service: A qualitative study of the independent sector treatment centre programme," Social Science & Medicine, Elsevier, vol. 73(4), pages 522-529, August.
  • Handle: RePEc:eee:socmed:v:73:y:2011:i:4:p:522-529

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    References listed on IDEAS

    1. Oliver, Adam, 2007. "Inconsistent objectives – reflections on some selective health care policy developments in Europe," Health Economics, Policy and Law, Cambridge University Press, vol. 2(1), pages 93-106, January.
    2. Joanne Roberts, 2006. "Limits to Communities of Practice," Journal of Management Studies, Wiley Blackwell, vol. 43(3), pages 623-639, May.
    3. Amin, Ash & Roberts, Joanne, 2008. "Knowing in action: Beyond communities of practice," Research Policy, Elsevier, vol. 37(2), pages 353-369, March.
    4. Sheaff, Rod & Benson, Lawrence & Farbus, Lou & Schofield, Jill & Mannion, Russell & Reeves, David, 2010. "Network resilience in the face of health system reform," Social Science & Medicine, Elsevier, vol. 70(5), pages 779-786, March.
    5. Allen, Pauline & Croxson, Bronwyn & Roberts, Jennifer A. & Archibald, Kate & Crawshaw, Shirley & Taylor, Lynda, 2002. "The use of contracts in the management of infectious disease related risk in the NHS internal market," Health Policy, Elsevier, vol. 59(3), pages 257-281, March.
    6. Turner, S. & Lourenço, A., 2010. "Competition and Public Service Broadcasting: Stimulating Creativity or servicing Capital?," Working Papers wp408, Centre for Business Research, University of Cambridge.
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    Cited by:

    1. Alvaro S Almeida, 2016. "The Role Of Private Non-Profit Healthcare Organizations In Nhs Systems: Implications For The Portuguese Hospital Devolution Program," FEP Working Papers 577, Universidade do Porto, Faculdade de Economia do Porto.
    2. Waring, Justin & Bishop, Simon, 2013. "McDonaldization or Commercial Re-stratification: Corporatization and the multimodal organisation of English doctors," Social Science & Medicine, Elsevier, vol. 82(C), pages 147-155.
    3. OHE Commission, 2012. "Report of the Office of Health Economics Commission on Competition in the NHS," Monographs, Office of Health Economics, number 000168, January.
    4. Krachler, Nick & Greer, Ian, 2015. "When does marketisation lead to privatisation? Profit-making in English health services after the 2012 Health and Social Care Act," Social Science & Medicine, Elsevier, vol. 124(C), pages 215-223.

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