State and society in the English countryside: the rural community movement 1918-1939

This paper assesses the relationship between state and society in interwar rural England, focusing on the hitherto neglected role of the Rural Community Councils (RCCs). The rise of statutory social provision in the early twentieth century created new challenges and opportunities for voluntaryism, and the rural community movement was in part a response. The paper examines the early development of the movement, arguing that a crucial role was played by a close-knit group of academics and local government officials. While largely eschewing party politics, they shared a commitment to citizenship, democracy and the promotion of rural culture; many of them had been close associates of Sir Horace Plunkett. The RCCs engaged in a wide range of activities, including advisory work, adult education, local history, village hall provision, support for rural industries and an ambivalent engagement with parish councils. The paper concludes with an assessment of the achievements of the rural community movement, arguing that it was constrained by its financial dependence on voluntary contributions.

Provider diversity in the English NHS: a study of recent developments in four local health economies

Objectives: The overall objective of the research was to assess the impact of provider diversity on quality and innovation in the English NHS. The aims were to map the extent of diverse provider activity, identify the differences in performance between Third Sector Organisations (TSOs), for-profit private enterprises, and incumbent organisations within the NHS, and the factors that affect the entry and growth of new private and TSOs. Methods: Case studies of four Local Health Economies (LHEs). Data included: semi-structured interviews with 48 managerial and clinical staff from NHS organizations and providers from the private and Third Sector; some documentary evidence; a focus group with service users; and routine data from the Care Quality Commission and Companies House. Data collection was mainly between November 2008 and November 2009. Results: Involvement of diverse providers in the NHS is limited. Commissioners’ local strategies influence degrees of diversity. Barriers to the entry for TSOs include lack of economies of scale in the bidding process. Private providers have greater concern to improve patient pathways and patient experience, whereas TSOs deliver quality improvements by using a more holistic approach and a greater degree of community involvement. Entry of new providers drives NHS Trusts to respond by making improvements. Information sharing diminishes as competition intensifies. Conclusions: There is scope to increase the participation of diverse providers in the NHS, but care must be taken not to damage public accountability, overall productivity, equity and NHS providers (especially acute hospitals, which are likely to remain in the NHS) in the process.