Regulatory Capitalism and the UK Labour Government's Reregulation of Commissioning in the English National Health Service
Abstract:Today, policy analysts and regulatory governance scholars are sceptical about the capacity of the regulatory state hypothesis to describe change at the institutional level. For many, the hypothesis is a convenient oversimplification that fails to account for the hybridity of institutional arrangements within individual policy sectors and also for the divergence of reform trajectories across different national and sector-based policy contexts. This article assesses the influence of the key themes of the regulatory state on the UK Labour government's reregulation of National Health Service (NHS) commissioning organizations. Following the critics, it argues that these themes are only partially evident in the programme. While the government has codified previously informal relationships with policies like Patient Choice and has also subjected commissioning organizations to metaregulatory techniques, its reforms have neither displaced public ownership and the direct supply of commissioning services with markets and new mechanisms for rule making and standard setting, nor have the reforms divided labour within the state by creating an independent agency to regulate NHS commissioning organizations via technocratic means. Under the reforms, NHS commissioning continues to take place within a structure of bureaucratic relationships. However, the article suggests that the hybridity of regulatory techniques at work within the UK Labour government's reregulation of NHS commissioning lends weight to the claim that the current era is one of regulatory capitalism. It concludes with a discussion of the consequences of this finding for the public policy and regulatory governance literatures.
Document Type: Research Article
Publication date: January 1, 2011