Governing and Assuring

Governing and Assuring

Methods that involve governing and assuring provide clarity on what is expected and required, and range from regulation, inspection and contracts to national mandates, to encourage the spread and scale of innovations or improvements.

Five methods have been identified in this category and are summarised below.


The effectiveness of these methods will vary depending on context, but key strengths of methods which utilise governing and assuring include: 

  • Provides clarity for system on expectations and requirements[i]
  • Can support peer learning between different systems [ii]
  • Can provide intelligence to support local decision making and prioritisation
  • Can support exit from more intensive processes to achieve spread and promote sustainable scale

However, there will be limitations to these methods which may include:

  • May be unpopular or meet resistance
  • Risk of losing nuance and varied local priorities and characteristics between different places
  • May not change or create culture of innovation and improvement, focus on compliance rather than commitment.
  • Benchmarking or comparative data may create unintended consequences (e.g. for high performers where it may impact effort)
  • Distracts from other local priorities

Methods and Levers

Regulation, inspection and clinical audit

Included within inspection frameworks. This involves monitoring and feedback but also shared perceptions that this is taking place, which can have notable impact. Examples include:

Contractual obligation

Inclusion of individual interventions (or related duties) within standard contracts or legislative underpinnings. Examples include:

High level national signals or campaigns

Government or NHSE set overarching long-term priority areas which then flow through into longer term priorities (and thus help reduce barriers) in local system commissioning and national funding allocation. Support behaviour change to spread simple, well-developed change. Examples include:

Specific product signal

List of products set out as specific signal to local systems. Examples include

National mandates on product availability

Requirement for systems to make certain products (as designated by a national body) available to patients (either through legislation or standard contracts). Examples include:

  • NICE processes (technology appraisals and Highly specialised technology (HST) evaluations add hyperlink)
  • MedTech Funding Mandate

Practical considerations for use

Method or LeverStage of development *Audience and scale **Resources neededTimeframe
Regulation, inspection and clinical auditSpreadNational, localSupport from partner organisations leading inspections or clinical audit.1-3 years
Contractual obligationSpreadLocal Contractual/monitoring systems and support for ‘reluctants’1-2 years
High level national signals or campaignsSpreadNational, can be cross-cutting or targeted to clinical specialtyNational consensus / buy in; resources aligned to deliveryMonths to years
Specific product signalSpreadNational or regional; targeted to productNational consensus / buy in; resources aligned to deliveryMonths to years
National mandates on product availabilitySpreadLocal; targeted to productEvidence requirement; resources aligned to delivery6-18 months

* Stages of intervention development – Ideation, Proof of concept, Prototype/Testing, Spread

** Audience and scale – national/regional/local, targeted by clinical speciality / product/ problem

[i] Nuffield Trust. Achieving scale and spread: learning for innovators and policy-makers. Available from:

[ii] The Health Foundation. The Spread Challenge: How to support the successful uptake of innovations and improvements in health care. Available from: