Technocracy, the market and the governance of England's National Health Service

• Published in: Regulation & governance Vol. 14; no. 2; pp. 295 - 315
• Main Authors: Horton, David P., Lynch‐Wood, Gary
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01-04-2020; Wiley Subscription Services, Inc
• Subjects: Accountability; Employers; expertise; Experts; Governance; health care regulation; Health services; Market economies; Social learning; stakeholder engagement; Technocracy; Value; Values; United Kingdom > UK; England
• ISSN: 1748-5983; 1748-5991
• DOI: 10.1111/rego.12208

England's National Health Service, the fifth largest employer in the world, has become heavily influenced by expert authority and the market economy, which has had implications for accountability and the receptiveness of health decisions to stakeholder needs. One response has been the introduction of a range of regulatory provisions designed to facilitate effective governance and stakeholder engagement. These provisions are scrutinized using three conceptual devices: core accountability, social reporting and social learning. These devices have significant implications, as they enable technical experts to form closed communities, communicate among themselves mainly about economic and financial matters, and make decisions that aid the market without meaningful recourse to citizens. While technical experts are necessary to help manage complex areas, current arrangements reinforce an existing gap between economic and democratic values through hardened technocratic approaches to health care governance.