Available online 4 November 2023, 104941

England's NHS is being privatised as services are outsourced to private providers.

But why privatisation happens, and whether it prioritises ‘quality’ is unknown.

This study interviews healthcare commissioners and asks why services are outsourced.

Commissioners are responding to unmet need, national guidelines, financial pressures and politics.

Some instances of privatisation fail to prioritise quality in the outsourcing process.

England's NHS is experiencing rising privatisation as services are increasingly being delivered by private healthcare providers. This has led to concerns about the supposed benefit of this process on healthcare quality but the reasons for the increase – and whether processes prioritise quality – are not well understood. In-depth semi-structured interviews with 20 people involved in the commissioning process, sampled from 3 commissioning sites (regional health boards) are thematically analysed. Four key themes of reasons for outsourcing were identified: unmet need; the “choice agenda”; appetite for change amongst key individuals working at the commissioning body; and the impact of financial pressures. The study concludes that the experience of commissioners navigating the provision of healthcare with worsening social determinants of health and financial austerity means that decisions to use private providers based on anticipated quality are sometimes but not always possible - sometimes they constitute ‘accidents’, sometimes ‘emergencies’.

NHS

Privatisation

Outsourcing

Commissioning

Health policy

Quality

Contracting-out

© 2023 The Author. Published by Elsevier B.V.