School of Management

The Centre for Public Services Organisations

Decentralisation and Performance: Autonomy and Incentives in Local Health Economies

This project proposes to examine the impact of decentralisation upon the performance of `local health economies' - the term commonly used to refer to the community of NHS (and other) organisations in localities. The study will analyse the interactions amongst the organisations of the LHE to determine whether their "room for manoeuvre", the incentives they face and the local context affects the performance of the local NHS.

This is a qualitative, three-year study using a comparative case-study design of 3 contrasting LHEs. `Tracers' in each LHE will be used as examples of current policy priorities and will provide greater focus for the analysis. The methods will include documentary analysis, a survey of local staff, interviews, and observation of local planning meetings. Analysis will determine the effects of coordination mechanisms, autonomy and incentives upon performance by each case-study, organisational type and over time.

The study is highly relevant to the NCC-SDO call for proposals as it addresses the mix of coordination mechanisms within LHEs as sub-systems of the NHS and by tracing the interaction of these with incentives and performance. It addresses issues of current and future relevance to the NHS in England including Foundation Trusts, Patient Choice and earned autonomy. It will assess the implementation of these policies, analyse the pathways by which coordination mechanisms, autonomy and incentives can facilitate improved performance, and of the conditions for the optimal balance of these. The study will generate practical lessons for the NHS.

Conducted by a multi-disciplinary team and advised by senior NHS managers, the study will involve NHS staff in data collection and provide (interim and final) feedback to them. Dissemination will involve a report for NCC-SDO, and feedback to NHS decision-makers at all levels and academic communities through presentations and publications (in practice and peer-reviewed journals).



Final Report » 'Decentralisation and Performance: Autonomy and Incentives in Local Health Economies' (PDF, submitted July 2009, published 2010)

Conference presentation:
“Assessing performance in local health economies: going beyond the metrics” (Mark Exworthy) SDO Annual Conference, June 2009, Birmingham (copies available upon request)

Oral evidence to Health Select Committee inquiry into Foundation Trusts and Monitor:


The National Institute for Health Research Service Delivery and Organisation Programme (SDO)

The National Institute for Health Research Service Delivery and Organisation Programme (SDO) Programme (2006-2009)


SDO Project Details
Final Report (PDF)