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

Jonathan Hammond, Ewen Speed, Pauline Allen, Imelda McDermott, Anna Coleman and Kath Checkland

Public Management Review, 2019, vol. 21, issue 8, 1148-1169

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.

Date: 2019
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DOI: 10.1080/14719037.2018.1544660

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