Journal of Social Policy

Articles

Commissioning in the English National Health Service: What's the Problem?

KATH CHECKLANDa1 c1, STEPHEN HARRISONa2, STEPHANIE SNOWa2, IMELDA MCDERMOTTa2 and ANNA COLEMANa2

a1 Clinical Senior Lecturer, School of Community-based Medicine, 5th Floor, Williamson Building, University of Manchester, Oxford Road, Manchester M13 9PL

a2 School of Community-based Medicine, 5th Floor, Williamson Building, University of Manchester, Oxford Road, Manchester M13 9PL

Abstract

The English NHS is currently organised around a split between the ‘commissioning’ and the ‘providing’ of health care. There has been considerable critical comment about commissioning, focusing upon perceived inadequacies of the regulatory structure and a perceived lack of competence of the managers concerned. In this paper, we use empirical data from two detailed studies of commissioning to propose a third explanation of the difficulties that have been observed in making commissioning work. We apply Scott's institutional analysis to the issue, arguing that far from reflecting managerial incompetence, some of the difficulties experienced are inherent in the normative and cultural/cognitive pillars of the NHS institution, so that there is a lack of ‘fit’ between commissioning and the institutional characteristics of the NHS. We conclude by exploring the potential impact of the latest round of NHS changes on this institution.