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The purpose of this paper is to explore issues of medical engagement in the management and leadership of health services in the English National Health Service (NHS). The literature suggests that this is an important component of high performing health systems, although the NHS has traditionally struggled to engage doctors and has been characterised as a professional bureaucracy. This study explored the ways in which health care organisations structure and operate medical leadership processes to assess the degree to which professional bureaucracies still exist in the English NHS.

Drawing on the qualitative component of a research into medical leadership in nine case study sites, this paper reports on findings from over 150 interviews with doctors, general managers and nurses. In doing so, the authors focus specifically on the operation of medical leadership in nine different NHS hospitals.

Concerted attention has been focussed on medical leadership and this has led to significant changes to organisational structures and the recruitment and training processes of doctors for leadership roles. There is a cadre of doctors that are substantially more engaged in the leadership of their organisations than previous research has found. Yet, this engagement has tended to only involve a small section of the overall medical workforce in practice, raising questions about the nature of medical engagement more broadly.

There are only a limited number of studies that have sought to explore issues of medical leadership on this scale in the English context. This represents the first significant study of this kind in over a decade.

This paper reports on experience in making use of Health Act flexibilities and care trusts. Three areas were chosen for study because they were known to have attached priority to health and social care integration and were at the leading edge of development. Drawing on discussions at a series of seminars at which the experience of each area was presented and reviewed, the paper identifies a number of emerging lessons for the future of integration in a context in which the Government has established a Minister‐led review to explore what more needs to be done to encourage integration.

The purpose of this paper is to present a theoretical background for studying rhetoric and narratives as equipment for living. Analyzing a case study on spinning and the spin doctor in recent narratives with a major focus on the Danish TV-series Borgen. Arguing that narratives can be equipment for teaching.

Introducing rhetorical concepts as tools for an analysis of narratives (based on the work of Kenneth Burke).

The authors argue for the importance of rhetoric and narrative as tools for meaning-making, illustrate how spinning has become a major topic in recent fiction (and the TV-series Borgen in particular), and focus on how Borgen can be equipment for living from different “terministic screens.”

The authors analyze how a popular narrative as Borgen can be read as equipment for living, focussing on how the spin doctor has become a major character in fiction, and illustrate what the authors can learn from narratives about rhetoric and spinning.

The purpose of this paper is to describe the development of a narrative to redefine integrated care from the user's perspective, which is being promoted across England.

The content of the narrative for person-centred coordinated care, recently launched in England, is described. The need for the narrative is explained in the context of the failure of previous integrated care programmes to identify and deliver clear benefits to service users. The sources and stages of development of the narrative are described. The author considers its place in national policy, further content development and its potential to help those planning programmes of integration.

A clear consensus on the need to define integrated care from the service user perspective now exists in England, and a narrative now exists to fulfil this purpose which has been developed by service users, patient groups, care professionals and system leaders. It has radical potential to change service delivery but this will be subject to the degree of local adoption.

The paper is the first journal publication describing the narrative for person-centred coordinated care and creates a record of its developmental stages which will be of interest to system leaders, professionals and researchers in England and internationally.

Competition is now widely used as the means of choosing the providers of essential public services in the USA and the UK. Many different approaches are found in the USA and there are useful lessons for the UK. With particular reference to mental health and substance abuse services, describes the effects of using competitive tendering on users, providers, purchasers and citizens and examines the problems of specification, transaction costs, the use of consultants, supply, the level playing field, trust, innovation, local accessibility and accountability. Ends with discussion of co‐operation and collaboration and the emergence of monopolies and integrated delivery systems in the USA and concludes by finding politics and political decision making of overriding importance.

The purpose of this paper is to present an evaluation of a collaborative commissioning approach to improve quality and experience and reduce cost within integrated health and social care.

A multi-method approach is used involving qualitative interviews, documentary analysis and non-participant observation.

The findings suggest that the approach provides a suitable framework for the collaborative commissioning of integrated health and social care services.

Further research is now needed to provide a definitive evaluation of its value outside of Wales.

With the significant scrutiny on health systems, the approach demonstrates effectiveness in securing quality improvements, achievement of recognised care standards and patient outcomes, while providing scope for financial gains and a goal for stakeholders to engage in effective communication.

This research presents an innovative method for collaborative commissioning and reveals activities that appear to contribute to more effective commissioning processes.

A well-funded, four-year integrated care programme was implemented in south London. The programme attempted to integrate care across primary, acute, community, mental health and social care. The purpose of this paper is to reduce hospital admissions and nursing home placements. Programme evaluation aimed to identify what worked well and what did not; lessons learnt; the value of integrated care investment.

Qualitative data were obtained from documentary analysis, stakeholder interviews, focus groups and observational data from programme meetings. Framework analysis was applied to stakeholder interview and focus group data in order to generate themes.

The integrated care project had not delivered expected radical reductions in hospital or nursing home utilisation. In response, the scheme was reformulated to focus on feasible service integration. Other benefits emerged, particularly system transformation. Nine themes emerged: shared vision/case for change; interventions; leadership; relationships; organisational structures and governance; citizens and patients; evaluation and monitoring; macro level. Each theme was interpreted in terms of “successes”, “challenges” and “lessons learnt”.

Evaluation was hampered by lack of a clear evaluation strategy from programme inception to conclusion, and of the evidence required to corroborate claims of benefit.

Key lessons learnt included: importance of strong clinical leadership, shared ownership and inbuilt evaluation.

Primary care was a key player in the integrated care programme. Initial resistance delayed implementation and related to concerns about vertical integration and scepticism about unrealistic goals. A focus on clinical care and shared ownership contributed to eventual system transformation.

Investigates the opportunities for marketers within the newly reformed NHS and gives a personal view of where the marketing emphasis should be placed in the early years of a trust. Examines the nature of the marketing challenge and outlines a typical trust culture and surrounding political environment, within which any marketing activity must take place. Argues that marketing must be seen as a core philosophy that permeates throughout the organization, reflected in a “top ten” of marketing activities for a new trust. Explores alternative implementation structures and recommends that the chief executive takes the marketing lead. Concludes by predicting the growth in power of purchasers and future mergers among providers.

A critical commentary on policy and practice over time in English health and social care. The paper aims to discuss these issues.

Personal reflections based on prior experience as a senior leader in the English health and care system, combined with insights and relevant evidence from other senior leaders and health and care “think-tanks”.

Shifting the balance of care from a hospital to a community setting can potentially be cost-effective as well as improving quality for service users. However, it will require a change in the approach to planning and implementation, by focussing on service users and communities, rather than on statutory organisations. It will also require a greater level of integration between primary care, community health services, social care and the voluntary sector, and greater levels of “co-production” with service users and the public.

Front-line health and care leaders are generally unaware of the evidence base in this field. Emergent findings in this field need to be rapidly evaluated and then communicated to front-line leaders and practitioners.

Incorporates direct experience of senior leaders in the field together with the existing and emerging evidence base.