Autonomy and improved performance: lessons from an NHS policy reform

Abstract

Autonomy is currently seen by policy-makers in many countries as a possible mechanism for enhancing public sector performance. The authors examine a service reform (the National Health Service in England) in which more autonomy was given to better performing hospitals. Drawing on data from interviews with senior managers, the research suggests that despite being enmeshed in a politicized culture of regulations and guidance, autonomy is increasingly perceived positively and appears to depend on the extent to which organizations have the incentives and the capacity to respond to increased autonomy. The article presents findings that will be of value to policy-makers in many countries.

Keywords:

• Autonomy
• decentralization
• performance
• policy reform
• NHS

Acknowledgements

The authors are particularly grateful to the NHS Service Delivery Organization for funding this research and to those who took part in the interviews.

Notes

* The key point is that innovation is stymied by a combination of factors: past behaviour, uncertain ‘rules of the game’, greater exposure to financial risk and the desire to accumulate reserves for ‘a rainy day’ or possible capital projects.

Additional information

Notes on contributors

Paul Anand

Paul Anand is Professor of Economics at the Open University, Milton Keynes, and Research Associate at the Health Economics Research Centre, University of Oxford, UK.

Mark Exworthy

Mark Exworthy is Professor of Health Policy and Management at Royal Holloway, University of London, UK.

Francesca Frosini

Francesca Frosini is Senior Researcher: Health Policy at the King's Fund, London, UK.

Lorelei Jones

Lorelei Jones is a research fellow at the London School of Hygiene & Tropical Medicine, UK.