Access to public documents in a study of the NHS internal market: Openness Vs secrecy in contracting for clinical services

Abstract

This paper describes problems of gaining access to public documents in a qualitative study of the NHS internal market in Wales. Official Department of Health (DoH) guidance stresses the importance of 'openness' and requires contracts between NHS purchasers and providers to be made available on request. However, this study suggests that 'openness' policies do not always translate into straightforward research access, and must be seen as a topic of study rather than an aid to research. The research team experienced considerable difficulty in obtaining full contract documentation; requests were complied with only after follow-up letters; generic 'standard form' drafts were sent in lieu of final contracts; some contract schedules were not supplied with the main documents; and where full contracts were forthcoming, price and activity figures were sometimes omitted or blanked out. Moreover, some contracts depended on a substratum of trust and tacit understandings that were not reflected in the written documents and were not always communicated to the researchers. These problems illustrate the discrepancy that can exist between formal agreements of research access and the defacto secrecy that surrounds some areas of organizational work, where leakage of information might undermine an organization's ability to achieve its goals. Health Authorities were concerned that public scrutiny of contracts would reveal inconsistency in their dealings with different hospital Trusts, particularly regarding the level of penalties to be levied for poor performance. Trusts were concerned that scrutiny would show they were ignoring NHS pricing rules and charging different Health Authorities different tariffs for the same services.