No abstract

It is easier to increase autonomy for public hospitals than to increase local accountability. Hospital managers are likely to be interested in making decisions with less central government control, whilst mechanisms for local accountability are notoriously difficult to design and operate. Further consideration of internal governance of FTs is needed. In a deteriorating financial climate, FTs should be better placed to make savings, due to their more business-like practices.

ObjectivesTo assess the feasibility of recruitment, retention, outcome measures and intervention training/delivery among teachers, parents and children. To calculate a sample size estimation for full trial.DesignA single-centre, unblinded, cluster feasibility randomised controlled trial examining Social Stories delivered within a school environment compared with an attentional control.Setting37 primary schools in York, UK.Participants50 participants were recruited and a cluster randomisation approach by school was examined. Participants were randomised into the treatment group (n=23) or a waiting list control group (n=27).Outcome measuresAcceptability and feasibility of the trial, intervention and of measurements required to assess outcomes in a definitive trial.ResultsAn assessment of the questionnaire completion rates indicated teachers would be most appropriate to complete the primary outcome measure. 2 outcome measures: the Social Responsiveness Scale (SRS)-2 and a goal-based measure showed both the highest levels of completion rates (above 80%) at the primary follow-up point (6 weeks postintervention) and captured relevant social and behaviour outcomes. Power calculations were based on these 2 outcome measures leading to a total proposed sample size of 180 participant groups.ConclusionsResults suggest that a future trial would be feasible to conduct and could inform the policy and practice of using Social Stories in mainstream schools.Trial registration numberISRCTN96286707; Results.

New governance arrangements for NHS Foundation Trusts (FTs) aimed to replace centralized state ownership of acute English hospitals with a new form of social ownership. Under this, trusts would exist as independent public interest organizations on the model of mutuals and co‐operative societies. Assessing the impact of the new arrangements on the management structure of four acute hospitals, we demonstrate that FTs have failed to deliver social ownership and local accountability on this model. We suggest that policy‐makers should re‐frame the governance apparatus associated with mutualism and social ownership in terms of the concept of meta‐regulation. By re‐framing governors as meta‐regulators, regulatory institutions would acquire new powers to steer FTs towards sustainable forms of compliance via non‐coercive, non‐intrusive means.

This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 6. See the NIHR Journals Library website for further project information.