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Commissioning in Sickness & in Health: Reforming the NHS

Activity: Talk or presentation typesPublic Lecture/ Debate/Seminar


In June 2010 the UK Government published a White Paper, 'Equity and Excellence: Liberating the NHS ', followed by the 'The Health and Social Care Bill' which, in June 2012 became enshrined in British law. The bill engenders another round of major reforms in the NHS, conceived to decentralise and more controversially, accelerate the marketization of healthcare provision (Çalışkan and Callon 2010). The National Health Service is a much valued public good, yet despite the understandably emotive and embittered arguments both for and against the marketization of the NHS, we know relatively little about what marketization means in this context. For the first time, clinicians, managers, patients and service providers are required to come together in commissioning consortiums to arrange for the services necessary to meet what the Health and Social Care bill considers as reasonable requirements and determine which services are “appropriate as parts of the health service” (section 9, 2a). A consortium does not have a duty to provide a comprehensive range of services but only those health services which may deemed to be ‘most valuable’ to society. These efforts stand to create new and potentially conflicting orders of worth that could profoundly affect healthcare provision in the UK (Boltanski and Thévenot 2006). We have been working with the newly established Commissioning Boards to understand how their commissioning practices are shaping service provision and how these practices are helping (or hindering) the creation and operation of healthcare markets. We presents findings from in-depth interviews and workshops with clinical practitioners, Commissioning Board directors, health service providers and management & design consultants in the healthcare sector. Our findings reveal the different mechanisms being established to create and explicate new orders of worth across five different clinical commissioning groups. We present illustrative examples to show how: 1) centrally created strategy is framing local clinical commissioning groups’ actions, 2) locally generated clinical practices are shaping commissioning initiatives and 3) collaborative mechanisms are engendering the commissioning of new bundles of services. Our paper contributes to our understanding of the valuation of public goods by showing how commissioning practices are reframing notions of ‘sickness and health’ and reconfiguring healthcare provision.

External organisation (External collaborations)

NameLoughborough University