Reforming the National Health Service in England: The Problems of Delivering the Health and Social Care Act 2012

This thesis explores the implementation of the health policy reforms following the Health and Social Care Act 2012 in the National Health Service in England. The government introduced reforms in 2012 intending to marketise health services, but the reform largely fell short of achieving this aim. This thesis studies why it was so difficult to deliver the market-based reforms introduced by the 2012 Act. In order to address this question the study employs an institutionalist framework for understanding implementation, and the problems associated with this process. Case studies in three different CCG areas highlight that the dynamics between policy implementers and institutional factors influenced the delivery of the reforms. The conclusion that can be draw from the empirical findings is that: It was difficult to implement the market-based reforms introduced by the 2012 Act, because there were no supportive institutional settings for implementing the reforms on the ground. First of all, there were no clear policy goals for implementation, with the co-existed goals of improving competition and collaboration in health service commissioning. This allowed CCGs the space to make their own choices about how to deliver the market-based reforms. Second, the reforms failed to create appropriate and effective incentives for both CCGs and healthcare providers to support the reforms. Moreover, normative and cultural factors shaped commissioning decisions in ways that were significant at the point of delivering the reforms. Intensifying marketisation and competition was widely perceived as conflicting with the shared values, norms and cultural beliefs within the NHS organisations, which resulted in the resistance of commissioning bureaucrats against marketisation at the point of delivery.