Increasing autonomy in publically owned services: The case of community health services in England

Ailsa Cameron*, Pauline Allen, Lorraine Williams, Mary Alison Durand, Will Bartlett, Virginie Perotin, Andrew Hutchings

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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– The purpose of this paper is to explore government efforts to enhance the autonomy of community health services (CHS) in England through the creation of Foundation Trusts status. It considers why some CHS elected to become nascent Community Foundation Trusts (CFTs) while others had not and what advantages they thought increased levels of autonomy offered.

– Data are drawn from the evaluation of the Department of Health’s CFT pilot programme. Participants were purposively selected from pilot sites, as well as from comparator non-pilot organisations. A total of 44 staff from 14 organisations were interviewed.

– The data reveals that regardless of the different pathways that organisations were on, they all shared the same goal, a desire for greater autonomy, but specifically within the NHS. Additionally, irrespective of their organisational form most organisations were considering an almost identical set of initiatives as a means to improve service delivery and productivity.

Research limitations/implications
– Despite the expectations of policy makers no CFTs were established during the course of the study, so it is not possible to find out what the effect of such changes were. Nevertheless, the authors were able to investigate the attitudes of all the providers of CHS to the plans to increase their managerial autonomy, whether simply by separating from PCTs or by becoming CFTs.

– As no CFTs have yet been formed, this study provides the only evidence to date about increasing autonomy for CHS in England.
Original languageEnglish
Pages (from-to)778-794
Number of pages17
JournalJournal of Health Organization and Management
Issue number6
Publication statusPublished - 21 Sept 2015

Bibliographical note

Date of Acceptance: 10/10/2014


  • Autonomy
  • Community nursing
  • Marketization
  • National health service


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