Understanding power relationships in health care networks.

PURPOSE The purpose of this paper is to show that networks are emerging as a new, innovative organisational form in the UK public sector. The emergence of more network-based modes of organisation is apparent across many public services in the UK but has been particularly evident in the health sector or NHS. Cancer services represent an important and early example, where managed clinical networks (MCNs) for cancer have been established by the UK National Health Service (NHS) as a means of streamlining patient pathways and fostering the flow of knowledge and good practice between the many different professions and organisations involved in care. There is very little understanding of the role of power in public sector networks, and in particular MCNs. This paper aims to explore and theorise the nature of power relations within a network model of governance. DESIGN/METHODOLOGY/APPROACH The paper discusses evidence from five case studies of MCNs for cancer in London. FINDINGS The findings in this paper demonstrate that a model of bounded pluralism can be used to understand power relations within London MCNs. However, power over the development of policy and strategic direction is instead exerted in a top-down manner by the government (e.g. Department of Health) and its associated national bodies. PRACTICAL IMPLICATIONS The paper supports the argument that the introduction of rhetoric of a more collaborative approach to the management of public services has not been enough to destabilise the embedded managerialist framework. ORIGINALITY/VALUE This paper uses empirical data from five case studies of managed clinical networks to theorise the nature of power relations in the development and implementation of network reform in cancer services. Also, there is limited understanding of the nature of power relations in network relationships, particularly in relation to the public sector.