New Connectivities: Civil Society, the Third Sector and Dilemmas for Economically and Socially Sustainable Healthcare Delivery

The U.K. is now taking highly significant – and historic -- steps to open up the NHS to a wider market Among the proposed changes, as laid out in the recent NHS White Paper, ‘Equity and Excellence: Liberating the NHS’ (2011) and the Health and Social Care Bill (2012), is a greater role for civil society organisations and social enterprise, as well as the private sector (DOH, 2007; 2010). The effects of a more open market in healthcare on civil society groups, however, remain unclear and under-theorized. Traditionally held up as mediators between the state and the communities they serve, they are now being encouraged to perform new roles in a post-welfare world, including functioning as healthcare providers themselves, as well as patient advocates, in a competitive landscape where patients (or service users) can make choices under the ‘any qualified provider’ model laid out in the NHS White Paper (Ashton, 2010). Crucially, how will their traditional connectivities with user communities be affected – for better or for worse? What new relationships and networks are they forming to meet new challenges in this fast-changing landscape? And finally, how sustainable are these models of service delivery in an era of austerity and funding cuts? This project examined these issues by directly engaging with civil society organisations (charities and voluntary groups) state and non-state actors in the health and wellbeing sectors. Data were collected through intensive workshops, focus groups and a symposium led by the researchers and including invited experts from Canada, the Netherlands and the U.K.