Public access to NHS financial information: from a freedom of information regime to full open-book governance?

This paper investigates the access that health professionals, researchers, journalists and, ultimately, the public have to review spending in the English National Health Service (NHS). The ability of news organisations to inform debate and decision-making, particularly when hospitals face financial constraints, relies on accessible data. Theorists such as Patrick Dunleavy have suggested that developments in information communications technology induce a dialectical movement, involving changing governance and increasing transparency. Drawing on this premise, the article reviews the extent to which the NHS has moved from a ‘freedom of information regime’ to one of ‘full open-book governance’. Its methodology includes a combination of documentary and freedom of information data analysis, as well as in-depth interviews with directors of commissioning and provider services and national agencies. It argues that, while increased dissemination of information might be consistent with the government’s digital agenda, the NHS’s quasi-market operation and its relationship to the Freedom of Information Act mean that significant data remains inaccessible or costly to obtain.