Public sector entrepreneurship, governance, and accountability in ambulance services: A case study

This chapter discusses how and why National Health Service (NHS) organisations undertake the entrepreneurial step of creating subsidiary companies. The chapter is a case study narrative. The discussion includes aspects of organisational governance, public sector accountability, the broader NHS context, and increasing commercialisation of the NHS, which has revealed systemic market imbalances. The focus of the case study is to help inform how public sector organisations can strategically organise to respond and compete against structural market imbalances, using the example of the North East Ambulance Service (NEAS), and their creation of a fleet-maintenance subsidiary, North East Ambulance Service Unified Solutions (Neasus). The case study applies empirical research with the theoretical framework of constructivism. This is supported by the doctoral study of one of the authors, who is also an employee of NEAS. Seven in-depth interviews were conducted where the participants are all directly involved in the governance arrangements of the parent-subsidiary relationship. The chapter begins with a discussion of the broader context of entrepreneurship in the public sector, narrowing to the NEAS case, with findings from the interviews, and concluding remarks. The main finding is that there is a tension for NHS organisations facing an increasingly challenging operating environment with constrained resources, a political drive towards commercialisation, as set against the integral focus on patient care. This has led to increasing expressions of entrepreneurial activity, of which subsidiary company development has proven to be a viable means of trying to manage this tension between core values and a new economic reality.