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The entrepreneurial state: service exports in healthcare and criminal justice

Published online by Cambridge University Press:  09 March 2020

Neil Lunt*
Department of Social Policy and Social Work, University of York, Heslington, UK


This article analyses an overlooked element of public service marketisation, examining overseas export activity within healthcare and criminal justice. It explores the drivers, strategies, opportunities and risks of such activities, and the differences across policy sector. Focussing on contrasting experiences is an opportunity to understand the complex and differentiated operational and structural environments within which this form of “public entrepreneurialism” is expressed. There is a gap in our understanding of such developments and their promotion within the context of austerity. The paper discusses the implications of the entrepreneurial state for public sector reputation.

Research Article
Copyright © 2017 Informa UK Limited, trading as Taylor & Francis Group

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Arora, S., Charlesworth, A., Kelly, E., & Stoye, G. (2013). Understanding competition and choice in the NHS, IFS Public payment and private provision: The changing landscape of health care in the 2000s. London: Institute for Fiscal Studies.Google Scholar
Barry, K., & McFarlane, M. (2014). The partnership between the United Kingdom in developing probation and other criminal justice services and Turkey's path to accession. In McFarlane, M. & Canton, R. (Eds.), Policy transfer in criminal justice (pp. 1534). Basingstoke: Palgrave Macmillan.Google Scholar
Bellone, C. J., & Goerl, G. F. (1992). Reconciling public entrepreneurship and democracy. Public Administration Review, 52, 130134.CrossRefGoogle Scholar
Benavides, D. D. (2002). Trade policies and export of health services. In Health services: Global, regional and country perspectives (pp. 5369). Washington, DC: Pan American Health Organization, Program on Public Policy and Health, Division of Health and Human Development.Google Scholar
Bernier, L. (2014). Public enterprises as policy instruments: The importance of public entrepreneurship. Journal of Economic Policy Reform, 17(3), 253266.CrossRefGoogle Scholar
Blöndal, J. (2005). International experience using outsourcing, public-private partnerships, and vouchers. IBM Centre for the Business of Government. Paris: OECD.Google Scholar
BMA. (2013). Understanding the reforms … Choice and any qualified provider. London: Author.Google Scholar
Borins, S. (2002a). Leadership and innovation in the public sector. Leadership & Organization Development Journal, 23(8), 467476.CrossRefGoogle Scholar
Borins, S. (2002b). Loose cannons and rules breakers, or enterprising leaders? Some evidence about innovative public managers. Public Administration Review, 60(6), 498507.CrossRefGoogle Scholar
Bowen, G. A. (2009). Document analysis as a qualitative research method. Qualitative Research Journal, 9(2), 2740.CrossRefGoogle Scholar
Boyett, I. (1996). The public sector entrepreneur – a definition. International Journal of Public Sector Management, 9(2), 3651.CrossRefGoogle Scholar
Cahn, A., & Clemence, M. (2011). The Whitehall entrepreneur: Oxymoron or hidden army? London: Institute for Government.Google Scholar
Carpenter, D. P., & Krause, G. A. (2012). Reputation and public administration. Public Administration Review, 72, 2632.CrossRefGoogle Scholar
Chanda, R. (2002). Trade in health services. Bulletin of the World Health Organization, 80, 158163.Google ScholarPubMed
Clifton, J., & Díaz-Fuentes, D. (2008). The new public service transnationals: Consequences for labour. Work Organisation, Labour & Globalisation, 2(2), 2339.CrossRefGoogle Scholar
Coalition Government. (2011). Innovation, health and wealth. Retrieved from Scholar
Collins, P., & Byrne, L. (Eds.). (2007). Reinventing government again. London: Social Market Foundation.Google Scholar
Competition & Markets Authority. (2014). Private healthcare market investigation (Final Report, 2 April). London: Author.Google Scholar
Conlon, G., Litchfield, A., & Sadlier, G. (2011). Estimating the Value to the UK of education exports (BIS Research Paper Number 46). London: BIS.Google Scholar
Currie, G., Humphreys, M., Ucbasaran, D., & McManus, S. (2008). Entrepreneurial leadership in the English public sector: paradox or possibility? Public Administration, 86(4), 9871008.CrossRefGoogle Scholar
Daily Telegraph. (2011, September 26). Overseas patients owe NHS £60m. Daily Telegraph.Google Scholar
Daily Telegraph. (2013, March 24). Organs donated to the NHS are being given to paying private patients from countries such as Libya and Dubai. Daily Telegraph.Google Scholar
De Zilwa, D. (2005). Using entrepreneurial activities as a means of survival. Higher Education, 50, 387411.CrossRefGoogle Scholar
Dunning, J. (1989). Multinational enterprises and the growth of services: Some conceptual and theoretical issues. The Service Industries Journal, 9(1), 539.CrossRefGoogle Scholar
Edwards, N. (2013, August 3). Britain's healthy export: How to sell the NHS. Economist.Google Scholar
Exworthy, M., & Powell, M. (2012). Case studies in health policy: An introduction. In Exworthy, M., Peckham, S., Powell, M., & Hann, A. (Eds.), Shaping health policy: Case study methods and analysis (pp. 320). Bristol: Policy Press.Google Scholar
Farnsworth, K., & Holden, C. (2006). The business-social policy nexus: Corporate power and corporate inputs into social policy. Journal of Social Policy, 35(3), 473494.CrossRefGoogle Scholar
Gallarotti, G. (2011). Soft power: What it is, why it's important, and the conditions for its effective use. Journal of Political Power, 4, 2547.CrossRefGoogle Scholar
Garrett, M. (1995). A case study: Sale of railway consulting services. Australian Journal of Public Administration, 55(4), 6771.CrossRefGoogle Scholar
Gash, T., & Panchamia, N. (2013). When to contract: Which service features affect the ease of government contracting? London: Institute for Government.Google Scholar
Gash, T., Panchamia, N., Sims, S., & Hotson, L. (2013). Making public services markets work: Professionalising government's approach to commissioning and market stewardship. London: Institute for Government.Google Scholar
GOSH. (2016). Great ormond street annual report and accounts (2015/16). London: Author.Google Scholar
Grayling, C. (2013). Speech to World Probation Conference 9th October), World Probation Conference, London, 8–10 October.Google Scholar
Gregory, S., Dixon, A., & Ham, C. (2012). Health policy under the coalition government. London: King's Fund.Google Scholar
Health and Social Care Act. (2012). Retrieved June 23, 2016, from Scholar
Health Service Journal. (2011, October 7). ‘Hospital says Greek private patients owe £1.8m’. Health Service Journal.Google Scholar
Healthcare UK. (2014). Healthcare UK: Review of progress 2013/14 and business plan 2014/15. London: Author.Google Scholar
Healthcare UK. (2015). Enhancing the NHS through international engagement. London: Author.Google Scholar
Hill, D. (1996). Internationalisation of the public sector. Australian Journal of Public Administration, 55(4), 7276.CrossRefGoogle Scholar
HM Treasury. (2002). Selling into wider markets: A policy note for public bodies. London: HM Treasury Enterprise & Growth Unit.Google Scholar
HM Treasury. (2011). Department for business and skills. The Plan for Growth. London: The Stationary Office.Google Scholar
Home Affairs Committee. (2015). Evaluating the new architecture of policing: The college of policing and the national crime Agency - Home Affairs Committee, printed 3 February 2015.Google Scholar
Home Affairs Select Committee. (2013). Leadership and standards in the police: College of policing response to the committee's Third Report of Session 2013-14 - Home Affairs Committee, printed 26 June 2013.Google Scholar
Hood, C. (1991). A public management for all seasons? Public Administration, 69, 319.CrossRefGoogle Scholar
Hudson, J., & Kim, B. (2014). Exploring policy transfer in practice: A case study of UK-Korea policy learning activities. Policy & Politics, 42(4), 495511.CrossRefGoogle Scholar
Huws, U. (2008). The new gold rush: The new multinationals and the commodification of public service work. Work Organisation, Labour and Globalisation, 2(2), 18.CrossRefGoogle Scholar
Jarman, H. (2014). Healthcare, borders, and boundaries: Crossborder health markets and the entrepreneurial state. Policy and Society, 33(1), 111.CrossRefGoogle Scholar
Jones, J. (2013). UK service industries: Definition, classification and evolution. Newport: Office for National Statistics.Google Scholar
Kearney, C., Hisrich, R. D., & Roche, F. (2009). Public and private sector entrepreneurship: Similarities, differences or a combination? Journal of Small Business and Enterprise Development, 16(1), 2646.CrossRefGoogle Scholar
Kettle, D. (2000). The global public management revolution: A report on the transformation of governance. Washington, DC: Brookings Institution.Google Scholar
Kim, Y. (2010). Stimulating entrepreneurial practices in the public sector the roles of organizational characteristics. Administration & Society, 42(7), 780814.CrossRefGoogle Scholar
Kornberger, M. (2010). Brand society: How brands transform management and lifestyle. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Leonard, P. (2012, November 28). All aboard for NHS exports? Health Service Journal. Retrieved from Scholar
Liao, S., & Zhang, Y. (2014). A new context for managing overseas direct investment by Chinese state-owned enterprises. China Economic Journal, 7(1), 126140.CrossRefGoogle Scholar
Luban, D. (1998). The publicity principle. In Goodin, R. E. (Ed.), The theory of institutional design (pp. 154198). Cambridge: CUP.Google Scholar
Lunt, N., Exworthy, M., Hanefeld, J., & Smith, R. (2015). International patients within the NHS: A case of public sector entrepreneurialism. Social Science & Medicine, 124, 338345.CrossRefGoogle ScholarPubMed
Lunt, N., Mannion, R., & Exworthy, M. (2013). A framework for exploring the policy implications of UK medical tourism and international patient flows. Social Policy & Administration, 47(1), 125.CrossRefGoogle Scholar
Lunt, N., Smith, R. D., Mannion, R., Green, S. T., Exworthy, M., Hanefeld, J., … King, H. (2014). Implications for the NHS of inward and outward medical tourism: A policy and economic analysis using literature review and mixed-methods approaches. Health Services and Delivery Research, 2(2), 1–234.CrossRefGoogle Scholar
Lunt, N., Smith, R., Exworthy, M., Green, S. T., Horsfall, D., & Mannion, R. (2011). Medical tourism: Treatments, markets and health system implications: A scoping review. Paris: Directorate for Employment, Labour and Social Affairs, OECD.Google Scholar
Lyons, H. (2014). Should all NHS organisations be selling their services internationally? Retrieved June 27, 2016, from Scholar
Mabry, L. (2008). Case study in social research. In Alasuutari, P., Bickman, L., & Brannen, J. (Eds.), The sage handbook of social research methods (pp. 214227). London: Sage.CrossRefGoogle Scholar
Mause, K. (2009). Contracting out the state in the OECD world: What do we (not) know. Paris: OECD.Google Scholar
May, T. (2011). Social research: Issues, methods and research. Buckingham: McGraw-Hill Education.Google Scholar
Miles, I. (1993). Services in the new industrial economy. Futures, 25, July/August, 653672.CrossRefGoogle Scholar
Mintrom, M. (1997). Policy entrepreneurs and the diffusion of innovation. American Journal of Political Science, 41, 738770.CrossRefGoogle Scholar
Mintrom, M., & Norman, P. (2009). Policy entrepreneurship and policy change. Policy Studies Journal, 37, 649667.CrossRefGoogle Scholar
Morris, M. H., & Jones, F. F. (1999). Entrepreneurship in established organizations: The case of the public sector. Entrepreneurship Theory and Practice, 24(1), 7191.CrossRefGoogle Scholar
National Audit Office. (2006). The wider markets initiative. Report by the Comptroller and Auditor General, Comptroller and Auditor General, HC 799 Session 2005–2006. London: Author.Google Scholar
National Audit Office. (2012). Delivering public services through the markets: Principles for achieving value for money (NAO Principles Paper). London: National Audit Office Principles Paper.Google Scholar
National Audit Office. (2013). The role of major contractors in the delivery of public services. Report by the comptroller and auditor general, comptroller and auditor general, HC 810, Session 2013–2014. London: Author.Google Scholar
National Audit Office. (2016). Investigation into just solutions international. Report by the Comptroller and Auditor General, HC 738, Session 2015–2016. London: Author.Google Scholar
Nye, J. S. (2004). Power in a global information age: From realism to globalization. London and New York: Routledge.Google Scholar
Nye, J. S. (2008). Public diplomacy and soft power. The Annals of the American Academy of Political and Social Science, 616(1), 94109.CrossRefGoogle Scholar
Office for National Statistics. (2015). Statistical bulletin: Ownership of UK Quoted Shares: 2014, 2 September.Google Scholar
Osborne, D., & Gaebler, T. (1992). Reinventing government. Reading, MA: Addison Wesley.Google Scholar
Plimmer, G. (2014a, July 6). UK outsourcing spend doubles to £88bn under coalition. Scholar
Plimmer, G. (2014b, November 19). British outsourcing groups dominate public sector contracts. Scholar
Plimmer, G. (2015, April 12). Rich overseas patients help private hospitals beat recession. Scholar
Porter, M. (1990). The competitive advantage of nations. London: Macmillan.CrossRefGoogle Scholar
Raza, W. (2016). Politics of scale and strategic selectivity in the liberalisation of public services – the role of trade in services. New Political Economy, 21(2), 204219.CrossRefGoogle Scholar
Ritchie, J., & Lewis, J. (2003). Qualitative research practice: A guide for social science students and researchers. London: Sage.Google Scholar
Roberts, J. (1991). A medical malaise in hospital: Private medicine: the NHS's safety valve. BMJ, 302, 163166.CrossRefGoogle Scholar
Roberts, N. C., & King, P. J. (1991). Policy entrepreneurs: Their activity structure and function in the policy process. Journal of Public Administration Research and Theory, 1(2), 147175.Google Scholar
Rothman, S. (2011). Revising the soft power concept: What are the means and mechanisms of soft power? Journal of Political Power, 4(1), 4964.CrossRefGoogle Scholar
Sadler, R. J. (2000). Corporate entrepreneurship in the public sector: The dance of the chameleon. Australian Journal of Public Administration, 59(2), 2543.CrossRefGoogle Scholar
Sataøen, H. S., & Wæraas, A. (2015). Branding without unique brands: Managing similarity and difference in a public sector context. Public Management Review, 17(3), 443461.CrossRefGoogle Scholar
Sauvé, P. (2002). Trade, education and the GATS: What's in, what's out, what's all the fuss about? OECD Trade Directorate, Paris, Paper prepared for the OECD/US Forum on Trade in Educational Services 23–24 May, Washington, DC. USA.Google Scholar
Scott, J. (2004). A matter of record: Documentary sources in social research. New York: John Wiley & Sons.Google Scholar
Sinclair, S. (2014). Trade agreements, the new constitutionalism and public services. In Gill, S. & Cutler, A. C. (Eds.), New constitutionalism and world order (pp. 179196). Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Singapore Cooperation Enterprise. (2015). Partnering Singapore's public sector. Singapore: Author.Google Scholar
Social Enterprise UK. (2012). The shadow state. London: Author.Google Scholar
Trades Union Congress and the New Economics Foundation. (2015). Outsourcing public services. London: Author.Google Scholar
UKTI. (2014). UKTI security exports strategy. London: Author.Google Scholar
UNCTAD. (2015). Key statistics and trends in international trade 2015. United Nations Conference on Trade and Development, Geneva: UNCTAD.Google Scholar
Vandermerwe, S., & Chadwick, M. (1989). The internationalization of services. The Service Industries Journal, 9(1), 7993.CrossRefGoogle Scholar
Wæraas, A., & Byrkjeflot, H. (2012). Public sector organizations and reputation management: Five problems. International Public Management Journal, 15(2), 186206.CrossRefGoogle Scholar
White Paper. (2011). Equity and excellence: Liberating the NHS. London: DH.Google Scholar
Wilkins, R. B. (1994). Managing public sector exporting accountability issues. Australian Journal of Public Administration, 53(2), 172178.CrossRefGoogle Scholar
Wölfl, A. (2005). The service economy in OECD Countries (STI Working Paper 2005/3, Directorate for Science, Technology and Industry). Paris: OECD.Google Scholar
Yeates, N. (2009). Production for export the role of the state in the development and operation of Global Care Chains. Population, Space and Place, 15, 175187.CrossRefGoogle Scholar
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