The governance of pluralist health care systems: An initial review and typology.

We here argue that study of governance systems within increasingly pluralist health care systems needs to be broadened beyond traditionally public sector orientated literature. We develop an initial typology of multiple governance systems within the English health care sector and derive exploratory questions to inform future empirical investigation. We add to existing literature by considering the coexistence of - and possible tensions between - multiple governance systems in a pluralised health and social care system.

Are inspectors' assessments reliable? Ratings of NHS acute hospital trust services in England.

The credibility of a regulator could be threatened if stakeholders perceive that assessments of performance made by its inspectors are unreliable. Yet there is little published research on the reliability of inspectors' assessments of health care organizations' services. Objectives We investigated the inter-rater reliability of assessments made by inspectors inspecting acute hospitals in England during the piloting of a new regulatory model implemented by the Care Quality Commission (CQC) during 2013 and 2014.

Challenges of commissioning and contracting for integrated care in the National Health Service (NHS) in England.

For many years there has been a separation between purchasing and provision of services in the English National Health Service (NHS). Many studies report that this commissioning function has been weak: purchasers have had little impact or power in negotiations with large acute providers, and have had limited strategic control over the delivery of care. Nevertheless, commissioning has become increasingly embedded in the NHS structure since the arrival of Clinical Commissioning Groups (CCGs) in 2012.

Evaluating a complex system-wide intervention using the difference in differences method: the Delivering Choice Programme.

Objectives: We report the use of difference in differences (DiD) methodology to evaluate a complex, system-wide healthcare intervention. We use the worked example of evaluating the Marie Curie Delivering Choice Programme (DCP) for advanced illness in a large urban healthcare economy.

Methods: DiD was selected because a randomised controlled trial was not feasible.

How "accountable" are accountable care organizations?

Background: The establishment of accountable care organizations (ACOs) in the Affordable Care Act (ACA) was intended to support both cost savings and high-quality care. However, a key challenge will be to ensure that governance and accountability mechanisms are sufficient to support those twin ambitions.

Purpose: This exploratory study considers how recently developed ACOs have established governance structures and accountability mechanisms, particularly focusing on attempts at collaborative accountability and shared governance arrangements.

Delivering better end-of-life care in England: barriers to access for patients with a non-cancer diagnosis.

The End of Life Care Strategy (Department of Health, 2008) radically raised the profile of end-of-life care in England, signalling the need for development in planning and delivery, to ensure that individuals are able to exercise genuine choice in how and where they are cared for and die. Research has indicated that there have been continuing difficulties in access to high-quality and appropriate support at the end of life, particularly for patients with a diagnosis other than cancer. This article uses research findings from three case studies of end-of-life care delivery in England to highlight some of the barriers that continue to exist, and understand these challenges in more depth.

Supporting care home residents at the end of life.

The English Department of Health's 2008 End of Life Care Strategy reported that 17% of deaths in England occur in care homes, with the majority of these in the 85 years and over age group. Given this, the ageing population, and the projected increase in the number of people dying, it is evident that the number of deaths in care homes is likely to increase. The research presented here seeks to consider the factors that support residents to remain in care homes towards the end of life.

Should diabetes be commissioned through multidisciplinary networks, rather than Practice Based Commissioning?

Aims: Diabetes is recognized as a complex, long term, largely asymptomatic condition requiring self management skills, a range of health care professionals and articulated health services. Diabetes Networks have been introduced to provide guidance from people with diabetes and local health professionals with different skills to ensure that diabetes care is well organized, sustainable and delivers quality care. We have considered the role of Diabetes Networks in the English setting.

Evaluation of a pilot study day for healthcare assistants and social care officers.

Unlabelled: This report evaluates a pilot study day, which provided an introduction for healthcare assistants and social care officers into the causes, incidence and impact of symptoms encountered when providing palliative care for people with advanced disease.

Aim: To demonstrate whether the study day facilitated an increase in confidence and knowledge in key areas of symptom control, the degree of satisfaction with the study day and whether participants were able to use information from the study day in practice.

Method: Both qualitative and quantitative methods were employed in the evaluation process.

Centralisation of end of life care coordination: impact on the role of community providers.

Background The recently published End of Life Care Strategy (1) and emerging service improvements have raised the profile of end of life care (EOLC) across health and social care sectors. Policy emphasises providing patients with more choice over where they are cared for at the end of life. Surveys and anecdotal evidence suggest that the majority of people would prefer to be cared for (and die) in their own home.

Models of governance and the changing role of the board in the "modernised" UK health sector.

Purpose: The aim of this paper is to show that there has been an increasing focus on networks as a model of service delivery and governance in the UK public sector. As an early example, managed clinical networks for cancer were initially considered to represent an ideological move towards a softer model of governance, with an emphasis on moving across the vertical lines that were strengthened or established during the new public management (NPM) movement of the 1990s. The NPM ideology of the 1990s emphasised the role of Boards and powerful non-executives in governing public services.

Understanding power relationships in health care networks.

Purpose: The purpose of this paper is to show that networks are emerging as a new, innovative organisational form in the UK public sector. The emergence of more network-based modes of organisation is apparent across many public services in the UK but has been particularly evident in the health sector or NHS. Cancer services represent an important and early example, where managed clinical networks (MCNs) for cancer have been established by the UK National Health Service (NHS) as a means of streamlining patient pathways and fostering the flow of knowledge and good practice between the many different professions and organisations involved in care.