Between a rock and a hard place Comparing arms’ length bodies for public involvement in healthcare across the UK

Funded by

The Health Foundation Logo

6 April 2020

Published journal: Health Policy Journal


Arms' length bodies are often seen as a tool of technocratic governance, designed to insulate decision-making from the politicizing pressures of populist influence. This article examines a subset of arms' length bodies in the UK which challenge this convention: agencies which exist to 'champion' the voice of patients and the public in the four NHS systems (England, Northern Ireland, Scotland and Wales). We compare the functions of these agencies on paper and through qualitative interviews in each system which focused on public involvement in major service change (such as closing hospitals). We found that agencies in all four systems had struggled to demonstrate their legitimacy, squeezed between the demands of the elected Governments they answer to, the NHS organisations they are meant to support and challenge, and the publics whose voices they are meant to amplify. We argue that the evolving solutions found in each system demonstrate a foundational tension between locally-legitimate actors and nationally-capable political savvy.


Ellen Stewart, Angelo Ercia, Scott L. Greer, Peter D. Donnelly, Between a rock and a hard place: Comparing arms’ length bodies for public involvement in healthcare across the UK, Health Policy, Volume 124, Issue 4, 2020, p454-461, ISSN 0168-8510.

    You might also like...


    Data-driven tools in health and care


    Ellen Coughlan reflects on a recent workshop, exploring key questions about how to develop...

    Press release

    Government must go further to level up the health recovery

    Press release

    Health Foundation response to the Queen’s Speech 2022. 

    Press release

    Health and Care Act passes but leaves unfinished business for the NHS and social care 

    Press release

    Health Foundation respond to Health and Care Act receiving Royal Assent 

    Kjell-bubble-diagramArtboard 101 copy

    Get social

    There is a strong relationship between debt and health. Our analysis highlights that 20% of people in problem deb…

    Follow us on Twitter
    Kjell-bubble-diagramArtboard 101

    Work with us

    We look for talented and passionate individuals as everyone at the Health Foundation has an important role to play.

    View current vacancies
    Artboard 101 copy 2

    The Q community

    Q is an initiative connecting people with improvement expertise across the UK.

    Find out more