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

摘要

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. This paper seeks to explore the role of the Board in the UK health sector under the apparent emerging "post-NPM" ideological framework of accountability.Design/methodology/approach - The paper is based on findings from five comparative case studies of managed clinical networks for cancer in London.Findings - The paper finds that cancer network boards have had limited strategic influence as these networks are constrained by a continued emphasis of centralised performance management and structural reconfiguration, which become dominant during the NPM era.Practical implications - The inability of the post-NPM governance ideology to make a significant impact in the UK, and the resulting confused and conflictual framework, have hindered the initial intention of cancer networks as a forum for spreading best practice across organisational boundaries. Originality/value - There is only limited research on the emergent remit, structure or strategy of public sector Boards in the UK, and very limited research on the role of Boards in health care networks: the paper provides some illumination on this limited area of study.