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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.

The purpose of the study is to evaluate the first cohort of the Royal College of Physicians' (RCP) Chief Registrar programme in 2016/7. Chief Registrars provide medical leadership capacity through leadership development posts.

The study adopted a mixed methods design, comprising a monthly survey of the 21 Chief Registrars in the first cohort, interviews with Chief Registrars, and six cases studies where Chief Registrars and colleagues were interviewed.

Chief Registrars enjoyed high levels of practical, professional, and leadership support from their employing organisations, the RCP, and the Faculty of Medical Leadership and Management. They had high degrees of autonomy in their roles. As a result, roles were enacted in different ways, making direct comparative evaluation problematic. In particular, we identified variation on two dimensions: first, the focus on medical leadership generally, or quality improvement more specifically, and second, the focus on personal development or organisational leadership capacity.

The data are limited and drawn from the first cohort's experience. The Chief Registrar scheme, unlike many other leadership fellowships, maintains a high level of clinical practice (with a minimum 40 per cent leadership work). This suggests a clearer preparation for future hybrid leadership roles.

This paper may offer some support and guidance for Chief Registrars and those who work with and support them.

This study adds to the literature on leadership development for doctors in hybrid roles, and highlights the distinctiveness of the scheme compared with other schemes.

The purpose of this study is to explore how trainee hospital doctors led work-based projects undertaken on an accredited development programme in England.

This is a case study of a leadership programme for hospital-based specialty trainees. The programme included participants leading work-based projects which were submitted for academic accreditation. Accounts of 35 work-based projects were thematically analysed to explore how participants led their projects.

Leadership was often informal and based on a series of individual face-to-face conversations. The establishment of project teams and the use of existing communication processes were often avoided. The reasons for this approach included lack of opportunities to arrange meetings, fear of conflict in meetings and the personal preferences of the participants. The authors discuss these findings with reference to theory and evidence about conversations and informal leadership, highlighting the relevance of complexity theory.

The data are limited and drawn from the best accounts written for a specific educational context. There is therefore limited transferability to the leadership work of hospital-based specialty trainees in general. Future research into medical leadership might explore the micro practices of leadership and change, particularly in informal settings.

Leadership development programmes for trainee hospital doctors might concentrate on developing skills of conversation, particularly where there are or may be perceived power imbalances. Exploring conversations within the theory of complex responsive processes should be considered for inclusion in programmes.

This paper adds some detail to the general understanding of learning leadership in practice.

The publication of performance ratings for NHS Trusts (star ratings) is an important part of NHS policy. There are significant benefits to a Trust in being awarded the top rating of three stars. The methodology for awarding stars to acute hospitals is explained. The most significant areas of performance in determining a hospital's star rating are identified. The Department of Health claimed that performance in 2002 was better than in 2001, against standards that are getting tougher. This claim is assessed but no clear evidence is found to substantiate it. An alternative performance rating system using the same data is developed and compared with the official version to illustrate the importance of methodology – this system used only the outcome measures of hospital services included within the star ratings system, and not process measures. Only 41 per cent of hospitals would have received the same number of stars as their official rating. Some implications of the system of performance ratings are discussed.

The purpose of this paper is to identify some of the issues that will shape the future of regulation in England, with a focus on acute hospitals.

This is a discussion paper identifying recent policy developments, with a commentary drawing on theory and evidence.

From April 2010, there will be a new system for the regulation of health care and adult social care in England. The new system is a significant development. The Care Quality Commission, the new regulator, has had to create a new organisation from three predecessors, and will be implementing new systems for registering providers and monitoring compliance against new regulations. With an election only months away, the levels of public and political scrutiny are high. The development of the new system should be informed by a research and evaluation agenda. Leaders in both the regulator and the regulated organisations will need to develop their own processes of enquiry to support the development of the new system.

There is no attempt at originality but the paper provides information of value to those involved with health and social care in the UK.

Kinship structures in Ambridge have been analysed using social network analysis (SNA) showing a network of a ‘small world’ type with 75 individual people linked by birth or marriage. Further, the network shows four major cliques: the first two centred on Aldridge and Archer matriarchies and the second where through the marriages of the third generation the Grundies, Carters, Bellamies and Snells connect together. The chapter considers the possible futures for kinship networks in the village, arguing either a version of the status quo or The Headlam Hypothesis through which Archers assume less importance and the strength of the weak ties in the network assume more prominence.

As a network analyst, I am fascinated by social interactions. The ways in which people connect with one another and exercise power and authority by deploying different forms of capital. This piece returns to the underlying and changing kinship network structure of the village of Ambridge over time, explores the role of ‘kin-keeping’ as deployed by the matriarchs Peggy and Jill. I am most interested in the ways in which gender as performed by the women of the village intersects with abundance or lack of other forms of capital, and how far inequalities persist and why. It is clear that there is an intergenerational power dynamic at play in the spreading or hoarding of the various dimensions of power layered together and how forms of capital intersect for protection or precarity. Social and cultural capital at birth in the village is defining in terms of both ‘serious’ life outcomes as well as how more minor infractions and foibles are viewed. Further, I return to discuss how my various network-based predictions have fared over time. The Headlam Hypothesis and the fate of Ed Grundy – King of Ambridge are revisited and their durability explored.

Index by subjects, compiled by K.G.B. Bakewell covering the following journals: Facilities Volumes 8‐17; Journal of Property Investment & Finance Volumes 8‐17; Property Management Volumes 8‐17; Structural Survey Volumes 8‐17.