Education commissioning by consortia: some theoretical and practical issues relating to qualitative aspects of British nurse education.

In 1995 the British National Health Service (NHS) Executive published details of a new framework for planning and commissioning education and training in the NHS. Among the central elements of these new arrangements are consortia of representatives from health care provider organizations and purchasing authorities among others, who will in due course take on responsibility for the commissioning of non-medical education and training (NMET). This NMET market is clearly distinct from the larger 'internal market' for health care provision by virtue of its separate funding, and different supply and demand side components. This paper includes an analysis of the new arrangements in terms of quasi-market theory and articulates a key role for consortia in harmonising the distinct markets for health services and NMET. A primary purpose of the paper is to examine the extent to which the new arrangements generally, and consortia in particular, can ensure that NMET contributes to NHS reform. Evidence from consortium development work in the South Thames Regional Health Authority, England, is discussed and it is argued that consortia will only perform effectively if they receive devolved real powers to an extent that persuades members to genuinely commit themselves to the proper development of consortia and the responsibilities of NMET commissioning. Finally a tendency to become preoccupied with education and training operations and processes rather than outputs is described and identified as a threat both to consortium effectiveness and educational innovation.