open space

Published: 31/10/2002, Volume II2, No. 5829 Page 31

Can clinical networks ever succeed when most NHS organisations remain so inward looking, ask Maggie MacIsaac and Justin Dix

Clinical networks, in which professionals work across organisational boundaries to improve services, are a key part of the government's modernisation programme. But there is an inherent paradox in this. It requires that those at the front line be accountable for most of the resources of the NHS while at the same time being prepared to give away substantial day-to-day control to networks.

Chief executives and clinical leaders have a key role in ensuring that networks make a significant shift to a customer-focused service. But the NHS is still centred on relatively conservative organisations which interact in conservative ways. It is crucial to encourage them to let go of some of their power and control.

NHS organisations need to become incubators for networks, providing a safe environment and a constantly developing physical context for progress and innovation. But this is sadly some way from the average acute hospital where some specialties are traditionally afforded eminence and others are Cinderellas, even when they have the status of a national service framework.

We have to encourage organisations to change culturally and be prepared to let networks have control over the resources that are genuinely at the front line. Traditional NHS organisations, particularly acute trusts, need to focus on ensuring that there are first-class facilities, keeping together services that are included in more than one network and those services not included in any networks. They also need to retain a major role in encouraging positive recruitment and retention.

Also, networks need control over resources without the encumbrance of a traditional organisational structure.

They must be run by able and inspiring leaders and management teams.

There will be many benefits to this approach. Clinicians' time will be freed to focus on priority service issues.

The approach fits comfortably with the view of public-private partnerships and with trusts forging new and more efficient partnerships around asset management and delivery of the IT agenda. Accountability is of course an issue, particularly for people who use services, as existing networks are finding, but it is not an insoluble problem. But formal evaluation of networks has so far been limited and needs to be more structured if we are to learn from the successes and problems experienced by the trail blazers. Research has shown that clinical governance frameworks are essential.

1The government is taking the NHS on a 10-year journey of fundamental modernisation.Networks are integral ingredients. But they are challenging for many people as they represent a different kind of force in healthcare: one that manages care pathways, care standards and care outcomes - not the physical or supporting structures for healthcare.There are also issues in the performance management system.At the moment, trusts are star-rated homogeneously - a system that may encourage an internal focus rather than one that pays attention to systems and networks. In future, both networks and trusts could be star-rated, but for different aspects of the total package that constitutes the NHS.

The rating of networks is something that patients and local communities should be able to recognise as relevant to their own experiences and needs and will help perceptions of the NHS to move away from a physical place, such as a hospital or surgery.

Networks can only achieve their potential if they are high on the agenda, locally and nationally.


1Managed Clinical Networks. NHS Executive south east region. September 2000.

Maggie MacIsaac is head of performance, directorate of health and social care, south.

Justin Dix is acting director of children's services, Woking primary care trust.