Autonomy, accountability, and ambiguity in arm’s-length meta-governance: the case of NHS England

Abstract

Meta-governance involves orchestrating the ‘rules of the game’ in public management. Arm’s-length bodies are particularly important vehicles for this. We consider the case of an arm’s-length body (NHS England) created to oversee the English NHS’ day-to-day operation, and remove ‘political interference’. Although mandated by the Department of Health it has increasingly operated as policy-maker, developing policies in tension with existing legislation, while Ministers have faded from public-facing accounts of service operation. This suggests NHS England operates as a meta-governor, insulating government whilst pursuing its own agenda, and raises crucial questions about governmental accountability whilst simultaneously making answers harder to obtain.