Variation from beginning to end

Considering that this was supposed to be a unified national initiative, it was astonishing just how varied the eight case study sites turned out to be, not only in the manner in which the innovation occurred, but also in the configurations of the TCs themselves. Looking back, it should have been obvious that they would come in all shapes and sizes. After all, every previous central innovation of this kind, such as day surgery units in the 1980s or NHS Walk-in Centres in the 1990s, had spawned a mass of varied models. Indeed the Modernisation Agency had made clear that TCs should vary depending on local circumstances. But what they had in mind was the rational redesign of the same basic principles according to the likely demand for particular surgical services in localities with dissimilar populations. In fact the huge variety that emerged depended more on the happenstance of local organisational culture, politics, finances, relationships and buildings than on any rational analysis of local healthcare needs.

In order to understand this variety, and also to lay the foundations for understanding just what it was that shaped the innovation and its varied fate over time in different localities (see Table 2.1), we start by reviewing the initial conditions at each site. What kind of organisations were these NHS trusts that decided to become part of the early TC movement? How and why were they in a position to do so? We look here at each site in turn, examining both the internal circumstances and the external environment of each. Then, in the following chapter, where we examine their motives for opening a TC, we will be in a position to see not only how widely and why those reasons varied from place to place but also how wide-ranging they were in any particular hospital. Yet – as we shall see – despite this variety, there were also common features across the eight sites that will help us to understand how and why such an innovation evolves.