On the character of the new entrepreneurial National Health Service in England: Reforming health care from within?

Abstract

Recent health care reforms in England, combined with financial austerity, have accelerated both corporatization and commercialization in the English National Health Service (NHS) and this has encouraged greater public sector entrepreneurialism (PSE). We advance this argument by examining the meaning and experience of corporatization in this sector, illustrating our argument with qualitative data from a specialist hospital at the forefront of this trend. We demonstrate how the policy and practice of corporatization is entangled with increased commercialism and how this shapes more entrepreneurial conduct from staff. Framed in terms of the recursive relationship between organizational dynamics and individual behaviors, we focus empirically upon the shifting epistemic boundaries associated with increased corporatization, describing the dissonant effects of these shifts upon individuals, their attempts to compartmentalize, and the ethical dilemmas that result. Through this case we draw conclusions about the emerging impact of corporatization, commercialization, and public sector entrepreneurialism across public services.