Sheepdog or watchdog? The role of statutory public involvement institutions in political management of the NHS, 1974-2010

Carlyle, Eleanor Ruth (2013) Sheepdog or watchdog? The role of statutory public involvement institutions in political management of the NHS, 1974-2010. PhD thesis, Birkbeck, University of London.

Abstract

Since 1974, governments have created a series of statutory public involvement institutions in the English NHS: Community Health Councils; Patient and Public Involvement Forums; Local Involvement Networks; and, from 2013, local Healthwatch. This study presents the role of these institutions as a puzzle, given the growth of alternative forms of public involvement. Public involvement in the NHS tends to be studied for its contribution to democratising the NHS or for its role in a choice-led consumer market, but these analyses generally focus on involvement led by NHS personnel or by independent patient organisations. This dissertation uses a different body of political science theory to assess roles that statutory public involvement institutions may play in Ministers’ political management of the NHS. One approach is to see these institutions as ‘sheepdogs’, rounding up and organising diverse groups, thus providing a form of corporatist interest intermediation. Alternatively, they could be ‘watchdogs’, raising the alarm when standards slip critically and thereby helping to safeguard the NHS against disasters. The explanatory value of these two interpretations is reviewed over the period 1974-2010, using policy documents and archive material, including the records of these organisations and the archives of public inquiries into problems in hospitals. The findings suggest that at various times national political actors have used statutory public involvement institutions to manage the representation and mobilisation of interests and to alert them to problems in local health services. There is more recent evidence for the watchdog than for the sheepdog role. The watchdog role has been reappraised following the failure of statistical monitoring and regulatory police patrols to prevent disasters in the NHS. The discussion also shows how the sheepdog powers of these institutions mean that they can round up opposition, rather than moderating it, resulting in Ministerial reforms to statutory public involvement institutions.

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