Iestyn Williams

Despite the increasing popularity of the concept of 'public value' within both academic and practice settings, there has to date been no formal review of the literature on its provenance, empirical basis, and application. This paper seeks to fill this gap. It provides a critical introduction to public value and its conceptual development before presenting the main elements of the published literature. Following this, a series of key areas of disagreement are discussed and implications for future research and practice put forward. The authors argue that if the espoused aspirations for the public value framework are to be realized, a concerted process of research, debate and application is required. Although some criticisms of public value are argued to be unwarranted, the authors acknowledge ongoing concerns over the apparent silence of public value on questions of power and heterogeneity, and the difficulties in empirically testing the framework's propositions.

Work in progress not for citation without authors permission ... 14th Annual Conference of the International Research ... Work in progress not for citation without authors permission ... National Health Service (NHS) commissioning in England Within the UK, successive waves of ...

While purchasing and procurement have been central features of NHS reform for a number of years, recent policy developments in England have intensified the shift from what has been termed by central government “a provider led service” to one where commissioners drive ...

The economic downturn is placing increasing pressure on the financing of health care. For many health care providers, this means difficult decisions need to be made over what will and will not be funded. The NHS has not typically been good at decommissioning and ...

The world class commissioning (WCC) programme was introduced in the English NHS in 2007 to develop primary care trust (PCT) commissioning of health services. There has been limited evaluation of health commissioning initiatives over the years and in particular little is known about how commissioners interpret and implement initiatives and guidance intended to strengthen commissioning. This research explores the development and implementation of WCC and draws implications for future commissioning arrangements. This research draws on interviews with key informants (n = 6) and a literature review to analyse the aims of, and stimulus for, WCC. In-depth interviews (n = 38) were conducted in three PCTs in the north of England in 2009 to analyse the interpretation and implementation of WCC. The aims and rationale of WCC, in particular, the specification of commissioning skills and the aspirations to improve health outcomes, were largely welcomed and supported by interviewees. However, the implementation of WCC posed a number of challenges, including: availability of resources and knowledge; lack of a supportive organizational culture and networks; and the dominance of central government control. The findings have implications for emerging clinical commissioning groups (CCGs) in the English NHS. Specifically, the research highlights the need for a system-wide approach to improving commissioning, including appropriately aligned policy and objectives underpinned by a co-ordinated and supportive organizational culture.

In the context of an austere financial climate, local health care budget holders are increasingly expected to make and enact decisions to decommission (reduce or stop providing) services. However, little is currently known about the experiences of those seeking to decommission. This paper presents the first national study of decommissioning in the English National Health Service drawing on multiple methods, including: an interview-based review of the contemporary policy landscape of health care decommissioning; a national online survey of commissioners of health care services responsible for managing and enacting budget allocation decisions locally; and illustrative vignettes provided by those who have led decommissioning activities. Findings are presented and discussed in relation to four themes: national-local relationships; organisational capacity and resources for decommissioning; the extent and nature of decommissioning; and intended outcomes of decommissioning. Whilst it is unlikely that local commissioners will be able to 'successfully' implement decommissioning decisions unless aspects of engagement, local context and outcomes are addressed, it remains unclear what 'success' looks like in terms of a decommissioning process.

Countries around the world are experiencing an ever-increasing need to make choices in investments in health and healthcare. This makes it incumbent upon them to have formal processes in place to optimize the legitimacy of eventual decisions. There is now growing experience among countries of the implementation of stakeholder participation, and a developing convergence of methods to support decision-makers within health authorities in making tough decisions when faced with the stark reality of limited resources. We call for further interaction among health authorities, and the research community to develop best practices in order to confront the difficult choices that need to be made.

The UK’s New Labour government (1997 – 2010) continually wrestled to find ways of giving more emphasis to a mixed economy of public service provision, entailing greater externalization. This underlying drive was often resisted, particularly at local level, but consistently re-emerged in government policy (Bovaird and Downe, 2006).  This chapter chronicles the form which this drive took in the period from 2004 to 2010, which we characterise as a move to ‘strategic commissioning’. Whereas innovative approaches do not normally sweep through the public sector very rapidly, the move to strategic commissioning in the UK has been embraced by (almost) all central government ministries.  Further, it is multi-sectoral not only in the sense that it covers provision of welfare services by the public, private and third sectors, but it is also being applied to almost all sub-sectors of public services.
This chapter explores: the development of strategic commissioning in a range of public services; its limitations; and, some of the drivers which have led this particular wave of innovation to spread much more quickly through the UK public sector than have most other innovations (particularly those which are imposed by central government). It shows how a range of models (often developed in Whitehall) are being interpreted and redefined at the local level so that there is wide variation in the approaches to strategic commissioning actually being used in practice.  The chapter ends by drawing some of the lessons emerging to date from experience with the UK strategic commissioning approach and exploring the implications for the era of fiscal restraint under the new coalition government in the UK in which service decommissioning is becoming the dominant trend.  We start however, by setting out an overview of the policy context.  In doing so we describe the move to commissioning of public services in the UK as occurring in two waves – the first in the late 1980s and early 1990s, and the second more recently, essentially since 2004.