ABSTRACT
In this concluding chapter, we draw the threads together and highlight the main findings and conclusions. The book as a whole has reviewed the course of innovations and attempted innovations across 70 plus years of the NHS. The analysis reveals aspects that remain broadly the same and institutional features, which are seemingly hard to alter. It also reveals numerous attempts to reform and reorganise. These attempts have sometimes been on a large, national scale, and many more have been small, local scale. The linkages between these levels have been of special interest in this book. Many of the top-down reforms and reorganisations often failed to deliver meaningful innovation; but some did. There was an evident pattern: although top-down policy innovations did not automatically result in innovations in practice at local level, local actors were often able to use the central sponsorship as a useful lever and a source of legitimacy when pressing their ‘own’ innovation attempts.
