Accountability:A Qualitative Study of Relationships between the Public Sector, the Voluntary Sector and Users of Health and Welfare Services in the Context of Purchase of Service Contracting

Abstract

Since Sir Roy Griffiths reported to the Secretary of State for Social Services on Community Care in 1988, the public sector (particularly national health services (NHS) and local government) in Britain, has become less involved in the direct provision of public services. Increasingly it has ‘contracted out’ this responsibility to extragovernmental, ‘independent’ private and voluntary sector organisations, co-ordinated through a quasi-market system. In this context, voluntary sector organisations have moved from the periphery to occupy a more central role in the new processes of public policy implementation. As a result, accountability of government to the general public has become indirect and more complex. In other words, although elected policy makers are no longer always directly responsible for service delivery, they remain accountable (publicly answerable). Given that it is important that government and organisations acting on its behalf are accountable for the use of public monies, this research examined how accountability was conceptualised and practised in the new operational environment. Using a grounded theory approach, the study explored accountability in the context of purchase of service contracting in the field of health and social welfare. Specifically using the concept of accountability, it examined the links and relationships between three ‘actors’ - public sector managers (local government - social services), voluntary sector managers (charities) and service users of contracted out services. A pluralistic analytical framework that draws upon concepts such as ‘clans’, ‘exit and voice’, ‘networks’ and ‘power’ is used to explain the research findings.