The entrepreneurial state: service exports in healthcare and criminal justice

Abstract

This article analyses an overlooked element of public service marketisation, examining overseas export activity within healthcare and criminal justice. It explores the drivers, strategies, opportunities and risks of such activities, and the differences across policy sector. Focussing on contrasting experiences is an opportunity to understand the complex and differentiated operational and structural environments within which this form of “public entrepreneurialism” is expressed. There is a gap in our understanding of such developments and their promotion within the context of austerity. The paper discusses the implications of the entrepreneurial state for public sector reputation.

Keywords:

• public sector entrepreneurialism
• health export
• commercialisation
• public sector reputation
• healthcare

Acknowledgement

The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR Programme, NIHR, NHS or the Department of Health.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes on contributor

Dr Neil Lunt is Professor of Social Policy, University of York. He has interests in the organisation, management and delivery of health and social services, research within policy and practice, welfare policy, and migration and welfare. He led an NIHR-funded project “Inward and outward implications for the NHS of Medical Tourism” and a review for OECD on medical travel. He is co-editor of the Elgar Handbook on Medical Tourism and Patient Mobility (2015).

ORCID

Neil Lunt http://orcid.org/0000-0002-4501-1999

Notes

1 According to ONS overseas investors have increased stakes in UK firms by 10 percentage points over past five years 2010–15 (ONS, 2015).

2 China’s State Owned Enterprises have engaged in a major strategy of overseas expansion, acting like private-sector multinationals (undertaking both greenfield investment and Merger & Acquisitions) mainly within resources markets but also high tech enterprise (see Liao & Zhang, 2014).

3 Its expertise includes affordable housing, e-government, health management, and public administration, management and reform.

4 NHS Overseas Enterprises was established in 1988 as the “international marketing arm of the NHS” (Benavides, 2002). There was also a Health Care Sector Group from 1995 focussed on public and private opportunities. NHS Global 2010–12 was the forerunner of Healthcare UK (Lunt et al., 2015)

5 Note some differences with private sector export rationale – where avoiding domestic overdependence, buffering downturn and economies of scale are more likely.

6 We sought NHS ethical approval to interview representatives of NHS organisations in the localities selected. The full Ethics application “Implications for the NHS of inward and outward medical tourism” was submitted to Sheffield Research Ethics Committee for consideration and approval (11/H1308/3). Local research and development approval and appropriate letters of access were then gained for each of our final fieldwork locations. Informed consent was a fundamental part of the study approach.

7 There are 83 Private Patient Units within NHS hospitals – most offering services to international patients.

8 Sataøen and Wæraas (2015) cite Kornberger’s (2010) idea that we are living in a “brand society” and managing and protecting reputation is key.

9 JSi received its first official mention in documents in December, 2014: “JSI is the commercial brand for the NOMS promoting products and services to international justice markets” (UKTI Security Exports Strategy of 2014, p. 19, 25).

10 Andrew Selous, response to written questions (10 February 2015)

Additional information

Funding

Material is drawn from a project funded by the National Institute for Health Research Health Services and Delivery Research Programme (project number 09/2001/21).