While some sociologists of health and illness might consider the commissioning of healthcare to be of only marginal relevance to their work, this book demonstrates that nothing could be further from the truth. There is a danger that the ‘Context’ chapter, full of the abbreviated jargon of CCGs, PCTs, PBCs, SHAs, LESs, DESs and more that flourishes in the NHS, could confirm their suspicions that such matters are best left to the economists, policy analysts and that catch‐all group – health service researchers. Such scholars could find themselves falling into the trap of implicitly denigrating the managerial work of commissioning as an object of sociological interest. However, the essence of commissioning, according to this book, is the strategic allocation of resources to, and monitoring of, health services. What could be of more importance to analysis of the structural conditions of healthcare? Commissioning arguably falls into that category of things that could be termed (after Star, 1999) ‘boring’ but where, in the infrastructure of the NHS, we find inscribed value‐laden and power‐charged versions of our social world.

The book aims to compile a large body of knowledge produced by the multi‐site Policy Research Unit in Commissioning and the Healthcare System (PRUComm) 2011–2018. This was a period of great upheaval for the English NHS resulting from the coalition government's Health and Social Care Act 2012 (HSCA). The contentious Act led to major reforms, apparently described by the then Chief Executive of the NHS as ‘big enough to be seen from space’. The Act caused (amongst other things) the abolition of Primary Care Trusts (organisations responsible for local health services), the movement of public health teams from the NHS to local authorities and a new relationship between central government and the health service. PRUComm's research focused on policy and practice of commissioning during this period. Primary research conducted across England and evidence reviews are summarised in chapters that explain: the establishment of clinical commissioning groups; involvement of clinicians in commissioning; changes to the commissioning of primary care services; use of the market tools of competition, collaboration and contracts; and the changing status of public health.

The coherence of the book rests on a prevailing concern to analyse how market forces are understood to work in the NHS with the consistent methodology of a realist approach. Systematic analysis of how different actors understood policies to work were compared with observations of practices. A realist approach is an entirely appropriate way of unpacking the contradictory logics of the HSCA, and exposing the gap between hoped‐for results and disappointing evidence. The detail and accuracy of the research are owed to in‐depth case studies, a commitment to longitudinal research and the triangulation of data sources (full disclosure – I can attest to the ‘lived reality’ depicted as I worked as a commissioner during the period studied which accounts to some extent for my championing of commissioning as an object of interest). It is possible that the level of detail in this book from extensive primary research could, for readers less than familiar with the intricacies of NHS organisational relationships, obscure the over‐arching narrative of the fragmentation wrought on commissioning structures by the HSCA.

The role of evidence and ideology, and the way in which local actors responded to conflicting policy demands, provides two important sub‐plots in this body of work. It was ideology rather than evidence that underpinned the moves to ‘liberate’ the NHS from managers and place it in the hands of clinicians. Another recurrent theme across the studies described in this book is the uncertain nature of policy which left commissioners to interpret conflicting regulations and guidance. Local actors had to somehow bridge the growing disjuncture between regulations which enforced competition, and policies which softened towards cooperation. New commissioning practices emerged and relational norms tempered contractual arrangements. The ways in which tensions between evidence and ideology played out, and the constraints and freedoms of local actors, are topics of broader relevance beyond the situated practice of commissioning in England.

The historical context provided in the book, and the efficiently explained economic theories of markets and hierarchies, makes it an invaluable resource to scholars of the NHS. This research helps to explain why there are such high hopes for new approaches to collaboration and integration. So‐called place‐based arrangements are required to knit back together the schisms in structures and relationships of commissioning caused by the HSCA 2012. Of more general interest is how commissioning policy is shown to have sought to intertwine the practices of organising healthcare and the ideologies of the market. The conclusions of the authors about the enduring importance of the planning functions of commissioning in a publicly funded system (if not the market tools) are further endorsed by recent events as we currently see the invisible hand of the market to be falling away in the NHS in the face of hierarchical planning responses to the pandemic.

尽管一些健康和疾病的社会学家可能认为医疗保健的投入与其工作仅具有微不足道的关联，但本书表明，事实并非如此。充满“ CCG”，“ PCT”，“ PBC”，“ SHA”，“ LES”，“ DES”等缩写词的“上下文”一章可能会证实他们的怀疑，即此类问题最好留给经济学家，政策分析师以及所有此类人员-卫生服务研究人员。这些学者可能发现自己陷入了隐喻地贬低委托管理工作这一社会学关注的对象的陷阱。但是，根据本书所述，调试的实质是对卫生服务进行战略性分配和监控的战略。对于医疗保健的结构条件分析，还有什么更重要的呢？调试可以说是可以归类的事情（在Star之后，1999年）“很无聊”，但在NHS的基础设施中，我们发现了我们的社交世界的铭刻着价值的和充满力量的版本。

该书旨在汇编2011-2018年调试和医疗保健系统（PRUComm）的多站点政策研究部门提供的大量知识。联合政府的《 2012年健康与社会关怀法》（HSCA）导致英国NHS经历了巨大的动荡。有争议的法案导致了重大改革，当时的国民保健服务行政总裁显然将其描述为“足够大，可以从太空看到”。该法令（除其他外）导致取消了初级保健信托基金（负责当地卫生服务的组织），公共卫生小组从NHS转移到地方当局，以及中央政府与卫生服务机构之间建立了新的关系。在此期间，PRUComm的研究重点是调试的政策和实践。在英格兰进行的主要研究和证据综述归纳在以下各章中：临床医生参与调试；改变初级保健服务的启用；使用竞争，合作和合同的市场工具；以及公共卫生状况的变化。

该书的连贯性主要取决于人们对如何以一致的现实主义方法论来分析市场力量如何在NHS中发挥作用的关注。系统分析了不同参与者如何理解工作政策，并将其与实践观察进行了比较。现实主义者的方法是解开HSCA矛盾逻辑，揭露期望结果与令人失望的证据之间差距的一种完全适当的方法。研究的细节和准确性归因于深入的案例研究，对纵向研究的承诺和数据源的三角划分（全面披露–我可以证明我在此期间担任专员期间所描绘的“真实存在”）研究了在某种程度上有助于我提倡将调试作为感兴趣的对象的原因）。

证据和意识形态的作用，以及当地行为者对冲突的政策要求做出反应的方式，在这一工作体系中提供了两个重要的子领域。意识形态而非证据证明了从管理人员“解放” NHS并将其交给临床医生的举动。本书描述的研究中的另一个反复出现的主题是政策的不确定性，这使专员不得不解释有冲突的法规和指导。地方行动者必须以某种方式弥补强制竞争的法规与软化合作政策之间日益分离的分歧。出现了新的调试惯例，关系规范调整了合同安排。证据与意识形态之间的张力表现出来的方式，以及当地行为者的制约与自由，

书中提供的历史背景以及对市场和等级制度的经济理论的有效解释，使其成为NHS学者的宝贵资源。这项研究有助于解释为什么人们对新的协作和集成方法寄予厚望。需要所谓的基于位置的安排来将HSCA 2012引起的结构和委托关系之间的分裂重新结合起来。更普遍的兴趣是如何显示出委托政策试图将组织医疗保健和意识形态的实践交织在一起市场。