Commodification and healthcare in the third sector in England: from gift to commodity—and back?

IMPACT

This article suggests why a different approach may be required for commissioning services from third sector providers than from, say, corporate or public providers. English systems for commissioning third sector providers contain both commodified elements (for example formal procurement, provider competition, commissioner–provider separation) and collaborative, relational elements (for example long-term collaboration, reliance on inter-organizational networks). When the two elements conflicted, commissioners and third sector organizations tended to try to work around the commodified elements in order to preserve and develop the collaborative aspects, which suggests that, in practice, they find de-commodified, collaborative methods better adapted to the commissioning of third sector organizations.

ABSTRACT

When publicly-funded services are outsourced, governments still use multiple governance structures to retain some control over the services provided. Using realist methods the authors systematically compared this aspect of community health activities provided by third sector organizations in six English localities during 2020–2022. Two modes of commissioning coexisted. Commodified commissioning largely embodied Washington consensus models of formal, competitive procurement. A contrasting, collaborative mode of commissioning relied more upon relational, long-term co-operation and networking among organizations. When the two modes conflicted, commissioners often favoured the collaborative mode and sought to adjust their commissioning to make it less commodified.

KEYWORDS:

• Commissioning
• commodification
• England
• inter-organization collaboration
• networks
• outsourcing
• third sector
• Washington consensus

Acknowledgements

The research on which this article is based was funded by the NIHR Health Services Delivery Research programme, grant NIHR 128107. The views and opinions expressed above are those of the authors, not necessarily those of the Health Services and Delivery Research Programme, NIHR, NHS or the UK Department of Health.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Rod Sheaff

Rod Sheaff is at the Peninsula School of Medicine in Plymouth, UK. He researches the relationships between organizational structures, production processes and policy outcomes in the health sector and the public sector more widely.

Angela Ellis-Paine

Angela Ellis Paine is Lecturer in Voluntary Sector Management at the Centre for Charity Effectiveness, Bayes Business School, City, University of London, UK. Her research focuses on voluntary organizations, volunteering, and community participation.

Mark Exworthy

Mark Exworthy is Professor of Health Policy and Management at the University of Birmingham, UK. He researches healthcare governance and policy implementation. In 2023 Policy Press published his book ‘The NHS at 75: the state of UK health policy’.

Rebecca Hardwick

Rebecca Hardwick is a Senior Research Fellow at the University of Plymouth, UK. She has a background in knowledge mobilization research, with a focus on third sector organizations, and her current research interests also include mental health service delivery.

Chris Q. Smith

Chris Q. Smith is a Teaching Fellow at the University of Birmingham, UK. His expertise includes: UK health policy, the sociology of morality, critical realism in empirical research, and using sociological theory to understand health systems and organizations.