Journey in Government Monopsony
: The Inter-organizational Relationship between the NHS Education Buyer/Commissioner and Middlesex University 1995-2013

  • Donal Walsh

Student thesis: Doctoral ThesisDoctor of Business (DBA)


This dissertation is about the in/stability over time of a contract-based inter-organizational relationship (IOR) which existed mostly under conditions of government monopsony (MG).The MG consisted of the institutional arrangements between the NHS and Higher Education sectors in England for the provision of education for the NHS non-medical professional workforce. The IOR was between the NHS education buyer (the ‘GM’) and Middlesex University (MU).An agent-centred historical institutionalism was used as the overall approach in the inquiry. The main components of the approach were resource dependence theory, concepts of historical dependence, and events in the IOR and its institutional and organizational environments. A multi-dimensional concept of IOR in/stability from the standpoints of the GM and MU which was grounded in the practices of the IOR was constructed. The inquiry traced the origins and subsequent development of the MG and the in/stability of the IOR over an 18 year period, 1995 - 2013.The main findings of the inquiry were:(1) The IOR originated in, and continued to exist mostly under conditions of MG (2) The IOR became less stable over time from the standpoint of MU; reductions in IOR stability occurred in dimensions of risk relating to the future performance of the IOR(3) Instability and threatened instability in the IOR were brought about mostly by the exercise of power by the GM and by the power dependence responses of MU.  The thesis developed in the dissertation is that instability and threatened instability in the IOR were due mostly to a power imbalance in the IOR, in favour of the GM, between the GM and MU. The source of that power imbalance was a combination of: • The resource dependency of MU on the IOR • The conditions of MG and bilateral monopoly under which the IOR existed.The dissertation is concluded with a critique of MG as a technique for public sector management. Recommendations are made for new NHS-HE inter-sector and IOR arrangements to be established which take account of power imbalances and relations of mutual dependence between stakeholders. Recommendations for further research are also made.
Date of Award29 Jun 2016
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorJurgen Enders (Supervisor)


  • resource dependence
  • monopsony power
  • historical institutionalism
  • inter-organizational relations
  • higher education management
  • government monopsony

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