Pauline Allen

Pauline Allen
London School of Hygiene and Tropical Medicine | LSHTM · Department of Health Services Research and Policy

PhD, MSc, MA, Solicitor

About

140
Publications
13,083
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2,626
Citations
Citations since 2016
60 Research Items
1487 Citations
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2016201720182019202020212022050100150200250
2016201720182019202020212022050100150200250
2016201720182019202020212022050100150200250

Publications

Publications (140)
Article
Purpose The article aims to argue that the concept of “distributed leadership” lacks the specificity required to allow a full understanding of how change happens. The authors therefore utilise the “Strategic Action Field Framework” (SAF) (Moulton and Sandfort, 2017) as a more sensitive framework for understanding leadership in complex systems. The...
Article
Full-text available
Research has demonstrated that pilots contain multiple shifting purposes, not all of which relate to simple policy testing or refinement. Judging the success of policy pilots is therefore complex, requiring more than a simple judgement against declared goals. Marsh and McConnell provide a framework against which policy success can be judged, distin...
Technical Report
This report forms part of a wider evaluation of the National Vanguard programme, funded by the NIHR Policy Research Programme and taking place between 2017 and 2021. The aim of this national evaluation is to explore the implementation and impact of the Vanguard New Care Models programme. This study forms part of a wide-ranging evaluation for the pr...
Article
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The recent growth of medicine sales online represents a major disruption to pharmacy markets, with COVID-19 encouraging this trend further. While e-pharmacy businesses were initially the preserve of high-income countries, in the past decade they have been growing rapidly in low-income and middle-income countries (LMICs). Public health concerns asso...
Article
The English National Health Service (NHS) constitutes a unique institutional context, which combines elements of hierarchy, markets and networks. This has always raised issues about competing forms of accountability. Recent policy has emphasized a move from quasi market competition towards collaboration in the form of new regional organizational ar...
Article
COVID-19 has thrown NHS procurement into the limelight, but the shortage of personal protective equipment (PPE) has complex origins. This article explores the long-lasting struggle for centralisation in NHS procurement and its impact on the current PPE crisis.
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In the context of welfare delivery, hybrid organisations mix public and ‘new’ market, social, and professional types of mechanisms and rationales. This paper contributes to our understanding of accountability within hybrid organisations by highlighting how accountability obligations can become hybrid, simultaneously formal and informal. Instead of...
Book
Contents: Inroduction ~ Pauline Allen, Kath Checkland, Stephen Peckham, Marie Sanderson and Valerie Moran Context: commissioning in the English NHS ~ Imelda McDermott, Pauline Allen, Valerie Moran, Anna Coleman, Kath Checkland and Stephen Peckham The development and early operation of Clinical Commissioning Groups (CCGs) ~ Anna Coleman, Imelda Mc...
Article
Full-text available
Policy driven change is challenging, with a significant gap between theory and practice. A key tension in enacting such change is achieving a balance between bottom-up development of local, context-specific approaches, and top-down, centrally determined policy solutions and their mutual sequencing. Ideal type models of the policy-making process env...
Chapter
Chapter 9 draws together key themes arising from the book about issues raised by commissioning in the context of a quasi-market for healthcare in the English NHS, such as governance and accountability, clinical engagement, co-ordination and fragmentation. The chapter presents an overview of how commissioning in health and healthcare has developed s...
Chapter
Chapter 2 provides the context, setting out the organisation and governance of commissioning in the NHS. It includes a short summary of the architecture of commissioning pre-Health and Social Care Act (HSCA12), and highlights the important changes which were brought about by the Act, including the abolition of Primary Care Trusts and Strategic Heal...
Chapter
Chapter 7 reports two aspects of research on contracting in the NHS. The first investigates how the policies to use contractual mechanisms including financial risk allocation work in practice. Most of the contractual relationships between NHS owned acute providers and commissioners were characterised by the use of general annual financial settlemen...
Chapter
Chapter 6 reports a longitudinal study of commissioners’ (and providers’) use of competition and cooperation. This chapter reports research which aimed to investigate how commissioners in local health systems managed the interplay of competition and cooperation in their local health economies, looking at acute, mental health and community health se...
Article
This book brings together selected research on commissioning healthcare in the English NHS carried out by national policy research unit in commissioning and the healthcare system (PRUComm) between 2011 and 2018. PRUComm is funded by the English Department of Health’s Policy Research Programme. The bookexplores the changes to commissioning in the En...
Article
A challenge facing health systems such as the English National Health Service (NHS), which operate in a context of diversity of provision and scarcity of financial resources, is how organisations engaged in the provision of services can be encouraged to adopt collective resource utilisation strategies to ensure limited resources are utilised in the...
Technical Report
Full-text available
Five years since the publication of the Five Year Forward View (NHS, 2014), the integration of health and social care at a 'system' level remains a central NHS policy priority in England. The NHS Long Term Plan (NHS, 2019a) further set out how organisations are to continue to work together collaboratively across bounded geographic territories with...
Article
The regulation of competition and procurement in the National Health Service 2015–2018: enduring hierarchical control and the limits of juridification – ADDENDUM - Dorota Osipovič, Pauline Allen, Marie Sanderson, Valerie Moran, Kath Checkland
Article
Purpose The purpose of this paper is to investigate the perceptions of key informants on a national support programme for the development of new care models (NCM) in England (2015/2016–2017/2018). It focuses on the perceived facilitators and barriers affecting the development and implementation of the NCM programme and offers some insight into the...
Article
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Objectives: To establish how quality indicators used in English community nursing are selected and applied, and their perceived usefulness to service users, commissioners and service providers. Methods: A qualitative multi-site case study was conducted with five commissioning organizations and their service providers. Participants included commi...
Article
Full-text available
Since 1990, market mechanisms have occurred in the predominantly hierarchical NHS. The Health and Social Care Act 2012 led to concerns that market principles had been irrevocably embedded in the NHS and that the regulators would acquire unwarranted power compared to politicians (known as ‘juridification’). In order to assess this concern, we analys...
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Health sector ‘reform’ has re-opened the question of what structural and managerial differences, if any, differences of ownership make to healthcare providers. Using new data from England this paper considers: 1. How do the internal managerial regimes of differently owned healthcare providers differ, or not? 2. In what respects did any such differe...
Technical Report
You can download our report at https://www.research.manchester.ac.uk/portal/en/publications/national-evaluation-of-the-vanguard-new-care-models-programme(82d5187d-38ee-4ef5-a264-89af2df7e0d0).html)
Article
Metaphors are inescapable in human discourse. Policy researchers have suggested that the use of particular metaphors by those implementing policy changes both influences perceptions of underlying reality and determines what solutions seem possible, and that exploring ‘practice languages’ is important in understanding policy enactment . This paper c...
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Full-text available
Objectives Explore the impact of changes to commissioning introduced in England by the Health and Social Care Act 2012 (HSCA) on cervical screening activity in areas identified empirically as particularly affected organisationally by the reforms. Methods Qualitative followed by quantitative methods. Qualitative: semi-structured interviews (with NH...
Article
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Purpose Neo-liberal “reform” has in many countries shifted services across the boundary between the public and private sector. This policy re-opens the question of what structural and managerial differences, if any, differences of ownership make to healthcare providers. The purpose of this paper is to examine the connections between ownership, orga...
Article
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...
Technical Report
Full-text available
The Health and Social Care Act 2012 (HSCA 2012) introduced major changes into the commissioning system for the English NHS in 2013. Primary Care Trusts (PCTs) were replaced with Clinical Commissioning Groups, clinically-led statutory bodies responsible for the planning and commissioning of health care services for their local area. A new arms-lengt...
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Background High-quality nursing care is crucial for patients with complex conditions and comorbidities living at home, but such care is largely invisible to health planners and managers. Nursing care quality in acute settings is typically measured using a range of different quality measures; however, little is known about how service quality is mea...
Article
High-quality primary care services are an essential part of a successful health service. However, the planning and management of such services is complex. Using evidence from a study of recent extensive changes in the English NHS, the authors highlight the need for local service oversight by managers who understand local conditions and needs. The r...
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Since 2008, health policy in England has been focusing increasingly on improving quality in healthcare services. To ensure quality improvements in community nursing, providers are required to meet several quality targets, including an incentive scheme known as Commissioning for Quality and Innovation (CQUIN). This paper reports on a study of how fi...
Article
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Objectives From April 2015, NHS England (NHSE) started to devolve responsibility for commissioning primary care services to clinical commissioning groups (CCGs). The aim of this paper is to explore how CCGs are managing potential conflicts of interest associated with groups of GPs commissioning themselves or their practices to provide services. De...
Article
The optimal balance between central governmental authority and the degree of autonomy of local public bodies is an enduring issue in public policy. The UK National Health Service is no exception, with NHS history, in part at least, a history of repeated cycles of centralisation and decentralisation of decision-making power. Most recently, a signifi...
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This paper explores how 'place' is conceptualised and mobilized in health policy and considers the implications of this. Using the on-going spatial reorganizing of the English NHS as an exemplar, we draw upon relational geographies of place for illumination. We focus on the introduction of 'Sustainability and Transformation Plans' (STPs): positione...
Article
The coordination of public services is an enduring challenge and an important policy priority. One way to achieve collaboration across organizational boundaries, which is being considered in public services such as the English National Health Service (NHS), is through the adoption of alliance contracting, prime provider contracting and outcome-base...
Article
The coordination of public services is an enduring challenge and an important policy priority. One way to achieve collaboration across organizational boundaries, which is being considered in public services such as the English National Health Service (NHS), is through the adoption of alliance contracting, prime provider contracting and outcome-base...
Article
Full-text available
Objective: The Health and Social Care Act 2012 ('HSCA 2012') introduced a new, statutory, form of regulation of competition into the National Health Service (NHS), while at the same time recognising that cooperation was necessary. NHS England's policy document, The Five Year Forward View ('5YFV') of 2014 placed less emphasis on competition without...
Article
The authors investigated how the formal national provisions for pricing in the National Health Service (which are a form of prospective payment, known as ‘Payment by Results’) are operationalized at local level. Transactions costs theory and existing evidence predict that actual practice often does not comply with contractual rules. A national stud...
Chapter
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Not only healthcare financing but also its provision was nationalised when the NHS was founded. Besides guaranteeing access to healthcare, Bevan and the other founders also intended to – and eventually largely did – ‘level up’ a supply side comprised of diversely-owned providers which provided correspondingly diverse levels of service access, quali...
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This book provides an in-depth analysis of the NHS reforms ushered in by UK Coalition Government under the 2012 Health and Social Care Act, arguably the most extensive reforms ever introduced in the NHS. Contributions from leading researchers from the UK, the US and New Zealand examine the reforms in the contexts of national health policy, commissi...
Article
Since the beginning of the 1990s the public healthcare system in England has been subject to reforms. This has resulted in a structurally hybrid system of public service with elements of the market. Utilizing a theory of new institutionalism, this article explores National Health Service (NHS) managers' views on competition and cooperation as mecha...
Article
Since the beginning of the 1990s the public healthcare system in England has been subject to reforms. This has resulted in a structurally hybrid system of public service with elements of the market. Utilizing a theory of new institutionalism, this article explores National Health Service (NHS) managers' views on competition and cooperation as mecha...
Article
Full-text available
Introduction The variety of organisations providing National Health Service (NHS)-funded services in England is growing. Besides NHS hospitals and general practitioners (GPs), they include corporations, social enterprises, voluntary organisations and others. The degree to which these organisational types vary, however, in the ways they manage and p...
Article
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This article examines the impact of the Health and Social Care Act 2012 on the regulation of competition in the English National Health Service (NHS), by focussing on the change it marked from a system of sector-specific regulation to one which is clearly based in competition law. It has been suggested that the Act and its associated reforms would...
Article
Many countries use state-owned, for-profit, and third sector organizations to provide public services, generating ‘hybrid’ organizational forms. This article examines how the hybridization of organizations in the public sector is influenced by interaction between regulatory change and professional communities. It presents qualitative data on three...
Article
The aim of this paper is to ascertain the impact of quasi-markets on contracting processes and factors affecting the costs of contracting in Finnish health care in the specific case of laboratory services. By means of a comparative case analysis, we ascertained the changes in organizational contracting practices and identified the actions affecting...
Article
The purpose of this paper is to explore government efforts to enhance the autonomy of community health services (CHS) in England through the creation of Foundation Trusts status. It considers why some CHS elected to become nascent Community Foundation Trusts (CFTs) while others had not and what advantages they thought increased levels of autonomy o...
Article
In England, ‘policy experiments’ are largely synonymous with the use of randomized controlled trials (RCTs) to test whether one policy ‘works’ better than another. While advocacy of the use of RCTs in public policy presents this as relatively straightforward, even common sense, the reality is different, as shown through analysis of three high profi...
Article
There is a need to develop a payment system for services for children with mental health problems that allows more targeted commissioning based on fairness and need. This is currently constrained by lack of clinical consensus on the best way forward, wide variation in practice, and lack of data about activity and outcomes. In the context of a natio...
Article
Contracting in the public sector is designed to enhance the accountability of service providers to their funders. The idea is that quality is improved by the use of service specifications, monitoring of performance and imposition of contractual sanctions. Socio-legal and economic theories of contract indicate that it will be difficult to make and e...
Article
Full-text available
OBJECTIVE The 2010 healthcare reform in England introduced primary care-led commissioning in the National Health Service (NHS) by establishing clinical commissioning groups (CCGs). A key factor for the success of the reform is the provision of excellent commissioning support services to CCGs. The Government's aim is to create a vibrant market of co...
Technical Report
Full-text available
This project investigates how commissioners in local health systems manage the interplay of competition and cooperation in their local health economies, looking at acute and community health services. This interim report focuses on commissioners’ and providers’ respective understandings of the policy and regulatory environment in which they operate...
Technical Report
Full-text available
Closer collaboration between primary care and community health services is a clear objective of the most recent NHS reforms. Currently, there is much emphasis on integrating healthcare services and in particular, moving care closer to home and out of the acute care setting by utilising Community Services and Primary Care. This report summarises the...
Article
Full-text available
Personal or individual budgets for purchasing health and social care are intended to offer more choice, control and flexibility to service users when compared with agency-directed care. They are becoming an increasingly common feature in high-income countries for purchasing personal care that often lies on the border line between health and social...
Article
Today, qualitative researchers are framing the relationship between qualitative case studies and quantitative evaluation research in positivist terms, seeking dialogue with quantitative researchers on the basis that qualitative case studies hold the potential to develop theory for evaluation programmes and to improve the quality of quantitative res...
Article
Following decades of change in health care structures and modes of funding, China has recently been making pilot reforms to the governance of its public hospitals, primarily by increasing the autonomy of public hospitals and redefining the roles of the health authorities. In this paper, we analyse the historical evolution and current situation of p...
Article
In England, policy piloting has become firmly established in almost all areas of public policy and is seen as good practice in establishing ‘what works’. However, equating piloting with evaluation can risk oversimplifying the relationship between piloting and policy-making. Using three case studies from health and social care – the Partnerships for...
Article
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As in many countries around the world, there are high expectations on academic health science centres and networks in England to provide high-quality care, innovative research, and world-class education, while also supporting wealth creation and economic growth. Meeting these expectations increasingly depends on partnership working between universi...
Data
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This report presents the findings of a comparative study of choice of provider in the UK.
Article
English health policy has promoted the diversity of providers of health care to NHS patients in recent years. Little research has been done to map the extent of actual and possible supply. Using data from four local health economies England the authors found that there was a low supply of such organisations, but that it is growing. Despite the grea...
Article
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One of the key goals of the current reforms in the English National Health Service (NHS) under the Health and Social Care Act, 2012, is to increase the accountability of those responsible for commissioning care for patients (clinical commissioning groups (CCGs)), while at the same time allowing them a greater autonomy. This study was set out to exp...
Article
A policy of separating all NHS community health services (CHS) from commissioning organisations (then primary care trusts) was launched in 2008. Some CHS were to become foundation trusts (FTs—in this case, CFTs). FTs are NHS organizations with greater autonomy from the centre, able to retain any surpluses, which are thought to be able to improve ef...
Article
Objectives To examine the types of choices available to patients in the English NHS when being referred for acute hospital care in the light of the divergence of patient choice policy in the four countries of the UK. Methods Case studies of eight local health economies in England, Scotland, Northern Ireland and Wales (two in each country); 125 sem...
Article
Full-text available
Background Over the past three decades, a limited range of market like mechanisms have been introduced into the hierarchically structured English National Health Service (‘NHS’), which is a nationally tax funded, budget limited healthcare system, with access to care for all, producing structures known as a quasi market. Recently, the Health and Soc...
Article
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Background This paper examines NHS secondary care contracting in England and Wales in a period which saw increasing policy divergence between the two systems. At face value, England was making greater use of market levers and utilising harder-edged service contracts incorporating financial penalties and incentives, while Wales was retreating from t...
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Using patient experience survey data, the paper investigates whether hospital ownership affects the level of quality reported by patients whose care is funded by the National Health Service in areas other than clinical quality. We estimate a switching regression model that accounts for (i) some observable characteristics of the patient and the hosp...
Article
In addition to introducing markets and market‐like structures into public services, New Labour wished to promote the involvement of users and the public in decision‐making in other ways than as individual consumers. One way was to involve the public in the governance of organizations. This could be done by removing public services from state contro...
Article
market reforms in England have been identified as making a clear distinction between English health policy and health policy in the devolved systems in Northern Ireland, Scotland and Wales. Patient choice is a high profile policy in the English National Health Service that constitutes significant changes to the demand side of health care. It is not...