Decentralisation has returned as a key theme in English health policy in recent years in
policies such as Patient Choice and Foundation Trusts, among many others. The goal of
these policies appears to be to stimulate self-sustaining incentives to continuous
organisational reform and performance improvement through creating a pluralist model of
local provision. However, the ability of local organisations to exercise autonomy and to
deliver such performance is highly contingent upon their local context, not least in terms of …