Decentralising the NHS: rhetoric, reality and paradox

Purpose – The purpose of this research is to examine the issues of decentralisation in the NHS. Design/methodology/approach – Evidence was gathered from an empirical study in order to illustrate the effect of policy reform on relationships at both the central and the local level. In this paper issues were examined in the context of two reforms at the heart of the decentralisation agenda in the English NHS: earned autonomy and the introduction of foundation hospitals. Findings – Past and current policy in the NHS reflects elements of both centralisation and decentralisation. The tension created by such opposing forces has an impact not only on inter‐organisational partnership working but also on the balance of power within local health economies. Originality/value – Attempts to control the NHS exhibit unresolved contradictions and tensions. This research showed that the challenge for policymakers, managers and clinicians is to manage such tensions.