CHLS Seminar: "Breaking with the past: A Deliberative Regulatory Approach to Address Inequalities in Accessing Healthcare Services in England"

20 November 2023, 12.00 PM - 20 November 2023, 1.30 PM

Sabrina Germain and Gianluca Veronesi

2.13 WMB and Hybrid

The Centre for Health, Law, and Society will be hosting Sabrina Germain and Gianluca Veronesi on 20th November 2023 to present a seminar entitled: "Breaking with the past: A Deliberative Regulatory Approach to Address Inequalities in Accessing Healthcare Services in England".

The SARS-CoV-2 pandemic has brought to the fore health inequalities arising from structural and systemic issues, among which, the unique barriers faced by vulnerable groups when engaging with healthcare services in England. The complex nature of the NHS as an organisation, with its different modes of coordination, hierarchies and its failure to adequately allocate and regulate the distribution of resources through healthcare law and policy have most certainly contributed to these growing inequalities.

Against this backdrop, we examine how resource allocation regulation could better address issues around barriers faced by vulnerable groups when accessing healthcare services in England. Regulation in this context is broadly understood as a public agency’s use of a technocratic device to exert control over an activity because of its importance or value to a community. In healthcare this should translate into the production of norms for the allocation of resources and accountability mechanisms for good governance and implementation.

Our analysis looks previous regulatory approaches to make sense of the shortcomings of the current arrangements for the governance of the NHS. We first analyse how reformative interventions have thus far been unsuccessful at translating into reality the equal access principles enshrined in the NHS at its foundation in 1948. We consider in turn, the social solidarity regulatory model adopted at the inception of the system, and the efficiency and patient choice regulatory model pursued in the 1990s and re-emphasised in the 2012 reform. In light of this analysis, the second part of this article explores the theoretical basis for an alternative regulatory model. We engage with academic work on the deliberative approach to regulation, which posits that a legitimate regulatory framework can only exist if stakeholders are subject to the rules they have agreed to through deliberations, and if they have collectively devised accountability mechanisms for the enforcement of these norms. After highlighting this approach’s potential to help reduce inequalities in healthcare, we flesh out a holistic and high-level normative framework. Our model emphasises the importance of vulnerable groups’ involvement in the rule making process and the design of accountability mechanisms for the allocation of healthcare resources. In the final part of the article we use the deliberative normative framework to evaluate recent law and policy choices. We use the 2022 Health and Care Act as a case study and assess whether the governance framework around its central feature, the Integrated Care Systems, now in charge of planning, coordinating and commissioning health and care services, is capable of addressing some of the long-standing challenges around inequalities in accessing the NHS.

Our reflection aims to provide an alternative deliberative framework to discuss resource allocation regulation in England, emphasising the importance of communication, co-creation and buy-in from the population, which are all essential elements to stumping down inequalities affecting vulnerable groups and contributing to a greater common good in healthcare.

This event is open to University of Bristol staff, students and members of the public. Please register to attend.

Contact Information
If you have any questions about this event, please contact the Centre Executive Assistant, Paige Spicer.


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