Diverse providers: behaviour in response to commissioners, patients and innovations

About the research study

What we are looking at

The variety of organisations providing NHS-funded services is growing. It is not just existing NHS hospitals, services and GPs. Instead, they increasingly include corporations, private firms, professional partnerships, social enterprises, voluntary organisations and others. The degree to which these organisational types vary both in the ways they manage and provide services and in their outcomes for service quality, patient experience and innovation, remains, however, unclear. This research, funded by the Department of Health (DH), aims to help those who commission NHS services and those who refer patients to select effectively between different types of organisation for different tasks.

What we will do

We are focusing on four NHS services heavily used by older people at high risk of hospital admission or re-admission: community health services, GP out-of-hours services, and secondary care (planned orthopaedics and ophthalmology). We will use a purposive sample of providers in order to give us the maximum variety of organisational types for each service. This will give us about 12 case studies. In each site we will adopt a mixed methods approach. This will include an organisational case study (including interviews with managers and commissioners) and a qualitative study of patient experience and choice (focusing on these same service providers).

The expected outputs will be evidence-based schemas. These will show how different organisational types of provider vary in their typical patterns of service development and delivery, and in how NHS commissioners may need to adapt their commissioning practice.

What we hope to find out

The frail elderly is a key demographic sector with significant policy and financial implications. This research is intended to help NHS commissioners to select and make contracts with providers in a more informed way, apprising provider development and competition policy. For patients, doctors and other stakeholders, we hope the main outcome will be better knowledge, hence more informed decision making, about the advantages and disadvantages of different kinds of healthcare provider.

What we aim to do on this web page

Our plans for telling people about this research will make use of a number of strategies suggested by patient and public involvement (PPI) as well as the DH and our service providers. We hope to use this website to tell you how the research is progressing and give you access to our findings as they emerge. We will at all times ensure our informants' organisational and individual anonymity.

Meet the research team

Professor Rod Sheaff

Rod Sheaff is Professor of Health and Social Services in the School of Government at Plymouth University. He is also part of PenCLAHRC (the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula). His research focuses on the relationships between organisational structures, production processes and policy outcomes in the health sector having researched in Germany, Italy, Russia, Portugal and the USA and elsewhere. Recent research includes: Integration and Continuity in Primary Care: Polyclinics and Alternatives, for NIHR Health Services and Delivery R&D Programme and the management and effectiveness of professional and clinical networks, for NHS Service Delivery and Organisation R&D Programme.

Professor Mark Exworthy

Mark Exworthy is a Professor of Health Policy and Management at the Health Services Management Centre, University of Birmingham. Mark has previously held posts at Southampton University, London School of Economics (LSE), University College London (UCL), Oxford Brookes and Royal Holloway University of London. He was also a Harkness Fellow in health care policy, based at University of California-San Francisco (UCSF) (funded by the Commonwealth Fund of New York). Mark is also currently a Visiting Professor at the University of California-San Francisco.

Professor Sheena Asthana

Sheena Asthana is Professor of Health Policy in the School of Law, Criminology and Government at Plymouth University. Her research programme spans four broad areas: NHS resource allocation; health care equity; health inequalities and evidence based public health; and health services evaluation. She has also been involved in research examining education and equity in the UK and on local government resource allocation. External responsibilities include: Membership of the Technical Advisory Group (TAG) to the Advisory Committee on Resource Allocation (ACRA) (DH); Steering Group Member, Rural England; and Council Member, Royal Society for Public Health, 2012. 

Professor Russell Mannion

Russell Mannion holds the Chair in Health Systems at the University of Birmingham where he is currently Director of Research at the Health Services Management Centre. As well as being a visiting professor at the Australian Institute for Health Innovation, Sydney he also holds a professorial position at the University of Oslo. He was previously Director of the Centre for Health and Public Services Management at the University of York. His research embraces health systems reform, clinical governance, health care quality and patent safety. He has won several international awards for his research including the Baxter European book award and he provides advice to a range of international governments and health bodies, including WHO and OECD.

Dr Pauline Allen

Pauline Allen is Reader in Health Services Organisation at the London School of Hygiene and Tropical Management where she is Head of the Department of Health Services Research and Policy. Pauline is also Deputy Director of PRUComm, the national Policy Research Unit in Commissioning and the Healthcare System funded by the Department of Health. She has researched health services governance for over 15 years after a first career as a company commercial lawyer. Her research interests include commissioning and contracting for health services, competition and co-operation in the NHS and different types of providers to the NHS. 

Dr Alex Gibson

Alex Gibson is Innovation and Research Fellow in the School of Government at Plymouth University. His research interests are primarily quantitative in nature and have recently focused on health services research, particularly access to health care and the development of resource allocation methodologies. His expertise in this project focuses on comparing service profiles, productivity and geographical disparities in service provision. 

Dr Joyce Halliday

Joyce Halliday is Associate Professor in Sociology in the School of Government at Plymouth University. Her research focuses on the impact of public policy and local initiatives targeting health and social exclusion. The majority (90 per cent) of her time is currently allocated to the Diverse Healthcare Providers project where she is Project Manager and main fieldworker, she also leads work package 2 on patient experience.

Jonathan Clark

Jonathan Clark is Lecturer in Sociology in the School of Government at Plymouth University, where he is also Associate Head of School (Teaching & Learning). His research interests lie in social and political theory and philosophy of social science including the discourses of regulation and professionalism. His interest in medical and health policy research dates from research investigating the discursive meanings of medical Revalidation at the Peninsula College of Medicine and Dentistry, Plymouth led by Dr Julian Archer and funded by The Health Foundation.

Funding

This research is funded through the Department of Health’s Policy Research Programme.