The effect of marketisation on the leadership of National Health Service (NHS) hospitals

This thesis tests and explores the impact of increasing competition (marketisation) on the leaders of NHS hospitals in England. The research was prompted by the researcher’s observations in practice that language and behaviours were changing to reflect an increasing sense of competition between NHS hospitals. Whilst published opinions are not difficult to find in relation to changing NHS policy, this unique academic investigation provides a new contribution to knowledge through evidence generated from a mixed methodological research process. A qualitative case-study involving telephone interviews with leaders at a single hospital site were conducted in late 2009. The findings were tested for generalisability across 20 NHS hospital sites as a larger cohort of comparable NHS leaders were targeted using a multi-site, on-line questionnaire in 2010. This thesis concludes that hospital leaders believe that competition exists between NHS hospitals. A significant proportion also believes that the sense of competition is increasing. This is evidenced through culturally significant research findings related to changes in leadership behaviour, language and actions as a consequence of increasing marketisation. Furthermore, hospital leaders are divided and clearly unconvinced that increased competition would be a good thing for the NHS. This has numerous implications for policy, leadership in practice, leadership and market theory and specifically, the NHS leadership development model - the NHS ‘Leadership Qualities Framework’ (LQF).