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Co-operation and conflict under hard and soft contracting regimes: case studies from England and Wales

David Hughes, Pauline Allen, Shane Doheny, Christina Petsoulas, Peter Vincent-JonesDavid, Pauline Allen, Shane Doheny, Christina Petsoulas, Peter Vincent-Jones

BMC Health Services Research, Volume: 13, Issue: Suppl 1, Start page: S7

Swansea University Author: David Hughes

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DOI (Published version): 10.1186/1472-6963-13-S1-S7

Abstract

BackgroundThis paper examines NHS secondary care contracting in England and Wales in a period which saw increasing policy divergence between the two systems. At face value, England was making greater use of market levers and utilising harder-edged service contracts incorporating financial penalties...

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Published in: BMC Health Services Research
Published: 2013
URI: https://cronfa.swan.ac.uk/Record/cronfa14396
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2014-03-31T13:57:50.2146785</datestamp><bib-version>v2</bib-version><id>14396</id><entry>2013-03-08</entry><title>Co-operation and conflict under hard and soft contracting regimes: case studies from England and Wales</title><swanseaauthors><author><sid>f1fbd458e3c75d8b597c0ac8036f2b88</sid><firstname>David</firstname><surname>Hughes</surname><name>David Hughes</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2013-03-08</date><deptcode>FGMHL</deptcode><abstract>BackgroundThis paper examines NHS secondary care contracting in England and Wales in a period which saw increasing policy divergence between the two systems. At face value, England was making greater use of market levers and utilising harder-edged service contracts incorporating financial penalties and incentives, while Wales was retreating from the 1990s internal market and emphasising cooperation and flexibility in the contracting process. But there were also cross-border spill-overs involving common contracting technologies and management cultures that meant that differences in on-the-ground contracting practices might be smaller than headline policy differences suggested.MethodsThe nature of real-world contracting behaviour was investigated by undertaking two qualitative case studies in England and two in Wales, each based on a local purchaser/provider network. The case studies involved ethnographic observations and interviews with staff in primary care trusts (PCTs) or local health boards (LHBs), NHS or Foundation trusts, and the overseeing Strategic Health Authority or NHS Wales regional office, as well as scrutiny of relevant documents.ResultsWider policy differences between the two NHS systems were reflected in differing contracting frameworks, involving regional commissioning in Wales and commissioning by either a PCT, or co-operating pair of PCTs in our English case studies, and also in different oversight arrangements by higher tiers of the service. However, long-term relationships and trust between purchasers and providers had an important role in both systems when the financial viability of organisations was at risk. In England, the study found examples where both PCTs and trusts relaxed contractual requirements to assist partners faced with deficits. In Wales, news of plans to end the purchaser/provider split meant a return to less precisely-specified block contracts and a renewed concern to build cooperation between LHB and trust staff. ConclusionsThe interdependency of local purchasers and providers fostered long-term relationships and co-operation that shaped contracting behaviour, just as much as the design of contracts and the presence or absence of contractual penalties and incentives. Although conflict and tensions between contracting partners sometimes surfaced in both the English and Welsh case studies, cooperative behaviour became crucial in times of trouble.</abstract><type>Journal Article</type><journal>BMC Health Services Research</journal><volume>13</volume><journalNumber>Suppl 1</journalNumber><paginationStart>S7</paginationStart><publisher/><issnPrint/><issnElectronic/><keywords>NHS contracts, markets, public healthcare, cooperation</keywords><publishedDay>31</publishedDay><publishedMonth>5</publishedMonth><publishedYear>2013</publishedYear><publishedDate>2013-05-31</publishedDate><doi>10.1186/1472-6963-13-S1-S7</doi><url/><notes>Published in BMC Health Services Research 13 (Supplement 1) (online only) 26 May 2013</notes><college>COLLEGE NANME</college><department>Medicine, Health and Life Science - Faculty</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>FGMHL</DepartmentCode><institution>Swansea University</institution><apcterm/><lastEdited>2014-03-31T13:57:50.2146785</lastEdited><Created>2013-03-08T10:23:21.9666826</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">School of Health and Social Care - Public Health</level></path><authors><author><firstname>David</firstname><surname>Hughes</surname><order>1</order></author><author><firstname>Pauline</firstname><surname>Allen</surname><order>2</order></author><author><firstname>Shane</firstname><surname>Doheny</surname><order>3</order></author><author><firstname>Christina</firstname><surname>Petsoulas</surname><order>4</order></author><author><firstname>Peter</firstname><surname>Vincent-JonesDavid</surname><order>5</order></author><author><firstname>Pauline</firstname><surname>Allen</surname><order>6</order></author><author><firstname>Shane</firstname><surname>Doheny</surname><order>7</order></author><author><firstname>Christina</firstname><surname>Petsoulas</surname><order>8</order></author><author><firstname>Peter</firstname><surname>Vincent-Jones</surname><order>9</order></author></authors><documents/><OutputDurs/></rfc1807>
spelling 2014-03-31T13:57:50.2146785 v2 14396 2013-03-08 Co-operation and conflict under hard and soft contracting regimes: case studies from England and Wales f1fbd458e3c75d8b597c0ac8036f2b88 David Hughes David Hughes true false 2013-03-08 FGMHL BackgroundThis paper examines NHS secondary care contracting in England and Wales in a period which saw increasing policy divergence between the two systems. At face value, England was making greater use of market levers and utilising harder-edged service contracts incorporating financial penalties and incentives, while Wales was retreating from the 1990s internal market and emphasising cooperation and flexibility in the contracting process. But there were also cross-border spill-overs involving common contracting technologies and management cultures that meant that differences in on-the-ground contracting practices might be smaller than headline policy differences suggested.MethodsThe nature of real-world contracting behaviour was investigated by undertaking two qualitative case studies in England and two in Wales, each based on a local purchaser/provider network. The case studies involved ethnographic observations and interviews with staff in primary care trusts (PCTs) or local health boards (LHBs), NHS or Foundation trusts, and the overseeing Strategic Health Authority or NHS Wales regional office, as well as scrutiny of relevant documents.ResultsWider policy differences between the two NHS systems were reflected in differing contracting frameworks, involving regional commissioning in Wales and commissioning by either a PCT, or co-operating pair of PCTs in our English case studies, and also in different oversight arrangements by higher tiers of the service. However, long-term relationships and trust between purchasers and providers had an important role in both systems when the financial viability of organisations was at risk. In England, the study found examples where both PCTs and trusts relaxed contractual requirements to assist partners faced with deficits. In Wales, news of plans to end the purchaser/provider split meant a return to less precisely-specified block contracts and a renewed concern to build cooperation between LHB and trust staff. ConclusionsThe interdependency of local purchasers and providers fostered long-term relationships and co-operation that shaped contracting behaviour, just as much as the design of contracts and the presence or absence of contractual penalties and incentives. Although conflict and tensions between contracting partners sometimes surfaced in both the English and Welsh case studies, cooperative behaviour became crucial in times of trouble. Journal Article BMC Health Services Research 13 Suppl 1 S7 NHS contracts, markets, public healthcare, cooperation 31 5 2013 2013-05-31 10.1186/1472-6963-13-S1-S7 Published in BMC Health Services Research 13 (Supplement 1) (online only) 26 May 2013 COLLEGE NANME Medicine, Health and Life Science - Faculty COLLEGE CODE FGMHL Swansea University 2014-03-31T13:57:50.2146785 2013-03-08T10:23:21.9666826 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Public Health David Hughes 1 Pauline Allen 2 Shane Doheny 3 Christina Petsoulas 4 Peter Vincent-JonesDavid 5 Pauline Allen 6 Shane Doheny 7 Christina Petsoulas 8 Peter Vincent-Jones 9
title Co-operation and conflict under hard and soft contracting regimes: case studies from England and Wales
spellingShingle Co-operation and conflict under hard and soft contracting regimes: case studies from England and Wales
David Hughes
title_short Co-operation and conflict under hard and soft contracting regimes: case studies from England and Wales
title_full Co-operation and conflict under hard and soft contracting regimes: case studies from England and Wales
title_fullStr Co-operation and conflict under hard and soft contracting regimes: case studies from England and Wales
title_full_unstemmed Co-operation and conflict under hard and soft contracting regimes: case studies from England and Wales
title_sort Co-operation and conflict under hard and soft contracting regimes: case studies from England and Wales
author_id_str_mv f1fbd458e3c75d8b597c0ac8036f2b88
author_id_fullname_str_mv f1fbd458e3c75d8b597c0ac8036f2b88_***_David Hughes
author David Hughes
author2 David Hughes
Pauline Allen
Shane Doheny
Christina Petsoulas
Peter Vincent-JonesDavid
Pauline Allen
Shane Doheny
Christina Petsoulas
Peter Vincent-Jones
format Journal article
container_title BMC Health Services Research
container_volume 13
container_issue Suppl 1
container_start_page S7
publishDate 2013
institution Swansea University
doi_str_mv 10.1186/1472-6963-13-S1-S7
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Public Health{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Public Health
document_store_str 0
active_str 0
description BackgroundThis paper examines NHS secondary care contracting in England and Wales in a period which saw increasing policy divergence between the two systems. At face value, England was making greater use of market levers and utilising harder-edged service contracts incorporating financial penalties and incentives, while Wales was retreating from the 1990s internal market and emphasising cooperation and flexibility in the contracting process. But there were also cross-border spill-overs involving common contracting technologies and management cultures that meant that differences in on-the-ground contracting practices might be smaller than headline policy differences suggested.MethodsThe nature of real-world contracting behaviour was investigated by undertaking two qualitative case studies in England and two in Wales, each based on a local purchaser/provider network. The case studies involved ethnographic observations and interviews with staff in primary care trusts (PCTs) or local health boards (LHBs), NHS or Foundation trusts, and the overseeing Strategic Health Authority or NHS Wales regional office, as well as scrutiny of relevant documents.ResultsWider policy differences between the two NHS systems were reflected in differing contracting frameworks, involving regional commissioning in Wales and commissioning by either a PCT, or co-operating pair of PCTs in our English case studies, and also in different oversight arrangements by higher tiers of the service. However, long-term relationships and trust between purchasers and providers had an important role in both systems when the financial viability of organisations was at risk. In England, the study found examples where both PCTs and trusts relaxed contractual requirements to assist partners faced with deficits. In Wales, news of plans to end the purchaser/provider split meant a return to less precisely-specified block contracts and a renewed concern to build cooperation between LHB and trust staff. ConclusionsThe interdependency of local purchasers and providers fostered long-term relationships and co-operation that shaped contracting behaviour, just as much as the design of contracts and the presence or absence of contractual penalties and incentives. Although conflict and tensions between contracting partners sometimes surfaced in both the English and Welsh case studies, cooperative behaviour became crucial in times of trouble.
published_date 2013-05-31T03:16:30Z
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