Learning from case studies of an NHS innovation

When the UK government announced in 2000 that over 40 major diagnosis and treatment centres (DTCs) would be introduced across the National Health Service (NHS), the idea was generally acclaimed as one whose time had come. DTCs were an innovative way of providing healthcare to thousands of patients with specific healthcare needs (see Appendix 1). Mostly purpose-built, DTCs would be designed to ensure that elective patients requiring straightforward diagnosis or treatment would avoid long waits and unnecessary hospital stays. DTCs would, moreover, spearhead the modernisation of ways of working in the NHS, another equally important priority that included the redefinition of professional roles and the spread of pre-defined pathways of patient care. Hospitals throughout the NHS rushed to get involved. Within a year of the original announcement, eight DTCs were already up and running, and by the end of 2006 there were 46 in place, with many more being planned. Yet, as with so many healthcare innovations, these DTCs or treatment centres (TCs), as they were later relabelled, did not turn out quite as central government had originally envisaged.

Although TCs are now an established part of the NHS, the lessons that we learned from studying their introduction remain poignantly relevant, since similar large-scale initiatives in the organisation and delivery of healthcare are – and are always likely to be – a continuing feature of central government policy making. There are many important questions one could ask specifically about TCs, such as whether the policy to establish them has been successful, how the new arrangements have affected patient experience and outcomes, whether professional roles changed for the better, what works or does not work in the management of elective patients and whether private sector involvement has improved the service. This book, however, focuses on a broader question – how local managers implement an innovation driven by national policy. That generic question will always retain far-reaching relevance since the tension between centrally driven, top-down policy and the local management of change is a permanent part not just of the NHS but any large healthcare system – indeed of any large public sector service in any country. And it is nearly always problematic.