Governing the Health Commons: An Institutional Analysis and Development (Iad) Framework on Health Devolution in Greater Manchester

Lazo, Kimberly (2019) Governing the Health Commons: An Institutional Analysis and Development (Iad) Framework on Health Devolution in Greater Manchester. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

In 2015, Greater Manchester (GM) has landed a landmark devolution deal in health with the government. National Health Services (NHS) England agreed to delegate some functions to the city-region, including strategic planning and administrative responsibilities. The GM Health and Social Care (GMHSC) Partnership was established in order to bring together local authorities, NHS organisations, and community-based institutions and to provide strategic direction and make collective decisions on behalf of the overall GM health and care economy. Using collective action, common property regimes, and collaborative governance as theoretical lens, this research argues that health systems leaders of a regional can come together as a collective unit and act as stewards of their health commons. They can devise institutional arrangements and use collaborative mechanisms in order to address collective action dilemmas and address the sustainability issue of the health commons. This research proposes an alternative solution in managing and sustaining the NHS. It aims to explore how formal and informal institutions emerged as a response to collective action dilemmas in the context of the Health Devolution policy and GMHSC Partnership. Using a qualitative approach, we used the Institutional Analysis and Development (IAD) framework to explore the role of rules and how they emerge as a response to collective action dilemmas, and how the (in)formal institutional arrangements facilitate and influence the interaction of the actors. Our findings suggest that the Partnership demonstrated that with the right combination of leadership, trust, and collective intention to resolve joint problems, then it is possible to overcome the political barriers of Devolution. They were able to successfully craft, enforce, and monitor their own institutional arrangements to overcome the limitations of the formal rules and to use them as countermeasures to self-seeking behaviour.