Governing the provider organisations
This chapter seeks to identify and unravel some of the main issues and tensions relating to the service provision side of health. It therefore assesses governance issues relating to the specialist teaching hospitals, the acute trusts and the NHS foundation trusts, mental health trusts, ambulance services and primary care provision including GP services and other forms of primary care provision. We group these together in this chapter and separate them from the commissioning trusts because this reﬂ ects the logic of the distinction between provider organisations responding to different incentives from commissioning organisations. The two sets are also overseen and regulated in different ways and by different bodies. For example the Care Quality Commission is a crucial regulator for provider organisations and, if they are foundation trusts, so too is Monitor. But, the commissioning bodies are regulated by neither of these. Instead, they are subject to direct oversight by the DH and the strategic health authorities. In future however, Monitor as the economic regulator will impact on the work of the commissioner organisations as it seeks to promote competition and set tariff levels. Also, in conjunction with the NHS Commissioing Board, it will seek to ensure commissioning decisions are fair and transparent. Both sets of bodies respond to different types of incentives and directions. Within the group of provider organisations there is then the question about the extent to which governance practice differs across these types of provider. This chapter will also make comparisons between the governance of health provision in England, Scotland, Wales and Northern Ireland.