title: Reducing emergency bed-days for older people? Network governance lessons from the 'Improving the Future for Older People' programme.
abstract: In 2007, the UK government set performance targets and public service agreements to control the escalation of emergency bed-days. Some years earlier, nine English local authorities had each created local networks with their health and third sector partners to tackle this increase. These networks formed the 'Improving the Future for Older People' initiative (IFOP), one strand of the national 'Innovation Forum' programme, set up in 2003. The nine sites set themselves one headline target to be achieved jointly over three years; a 20 per cent reduction in the number of emergency bed-days used by people aged 75 and over. Three ancillary targets were also monitored: emergency admissions, delayed discharges and project sustainability. Collectively the sites exceeded their headline target. Using a realistic evaluation approach, we explored which aspects of network governance appeared to have contributed to these emergency bed-day reductions. We found no simple link between network governance type and outcomes. The governance features associated with an effective IFOP network appeared to suggest that the selection and implementation of a small number of evidence-based services was central to networks' effectiveness. Each service needed to be coordinated by a network-based strategic group and hierarchically implemented at operational level by the responsible network member. Having a network-based implementation group with a 'joined-at-the-top' governance structure also appeared to promote network effectiveness. External factors, including NHS incentives, health reorganisations and financial targets similarly contributed to differences in performance. Targets and financial incentives could focus action but undermine horizontal networking. Local networks should specify which interventions network structures are intended to deliver. Effective projects are those likely to be evidence based, unique to the network and difficult to implement through vertical structures alone.
authors.affiliation: School of Government, University of Plymouth, United Kingdom.
authors.forename: Rod
authors.initials: R
authors.lastname: Sheaff
authors.affiliation: Community and Health Research Unit, University of Lincoln, United Kingdom. Electronic address: kwindle@lincoln.ac.uk.
authors.forename: Karen
authors.initials: K
authors.lastname: Windle
authors.affiliation: Personal Social Services Research Unit, London School of Economics and Political Science, United Kingdom.
authors.forename: Gerald
authors.initials: G
authors.lastname: Wistow
authors.affiliation: School of Nursing and Midwifery, Keele University, United Kingdom.
authors.forename: Sue
authors.initials: S
authors.lastname: Ashby
authors.affiliation: Research Institute for Primary Care and Health Sciences, Keele University, United Kingdom.
authors.forename: Roger
authors.initials: R
authors.lastname: Beech
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, United Kingdom.
authors.forename: Angela
authors.initials: A
authors.lastname: Dickinson
authors.affiliation: Personal Social Services Research Unit, London School of Economics and Political Science, United Kingdom.
authors.forename: Catherine
authors.initials: C
authors.lastname: Henderson
authors.affiliation: Personal Social Services Research Unit, London School of Economics and Political Science, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Knapp
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D015397:Program Evaluation; D013222:State Medicine / Q000458:organization & administration*
keywords: Aged 75 and over; Emergency admissions; Emergency bed-days; England; Governance; Network; Older people