In this chapter we begin by summarising our findings. We than consider some of their implications in terms of organisational theory before, in the final chapter, drawing out some practical conclusions and lessons.

Summary

When The NHS Plan was launched in 2000, TCs were a promising organisational innovation based largely on ideas stemming from a high profile prototype, rather than good research evidence. But their time had come and by 2003, as our study commenced, strong political and organisational forces were spearheading their rapid diffusion in the NHS as an attempt to reduce waiting times and waiting lists for common elective procedures and to foster new forms of patient-centred care. This was all part of a much wider government drive to modernise the organisation and delivery of NHS services, which meant that NHS TCs were launched into the complex milieu of sweeping changes. Some of those changes were always bound to impact on the fledgling TCs (see Chapter Four); they included the encouragement of independent sector TCs, by such measures as the introduction of the ‘G-Supp’ as part of a wider governmental push towards involvement of the private sector; Payment by Results as part of stimulating improvements in organisational performance; and Patient Choice and ‘Choose and Book’ as part of the desire to empower patients. As a result, the story of TCs was not about a single innovation and its impact on services, but about organisational responses to a maelstrom of modernisation. Nevertheless, the dedicated extra funding and the advice from sources such as the Modernisation Agency's ‘learning events’ gave an opportunity for local developments that, although often very different from the Department of Health's ideal, reflected many of its intended principles. The Department might not always have things its own way but the TC programme did stimulate local change that might otherwise not have occurred.

The eight sample sites that we studied differed greatly from each other in their management styles, aspirations and pressures. Their relationships with their external milieu – the host hospital, the PCT, the SHA and neighbouring trusts – and with their own staff also varied from harmonious and constructive partnerships through to downright hostility and conflict.