The aim of this thesis is to explore the role and nature of Community Interest Companies (CICs) in the delivery of health care services in the English NHS. CICs are a hybrid form of organisation insofar as they exist to generate wider social impact through their commercial practices. The thesis draws on theories of New Public Management and Governance to trace the changing role of the state in the context of public service delivery and highlights how these shifts facilitate the growth of alternative providers like CICs in publicly funded health care. To achieve this aim the thesis explores a number of connected questions analysing whether CICs are a new form of governance in health service delivery or the Emperorâs New Clothes? Is the claim to a wider social mission and greater accountability exclusive to CICs? Or could other providers of health care, both private and public, make a similar claim by virtue of what they do rather than their legal status? To this end the study examines three distinct areas which politicians and policy makers identified as most likely to benefit from the CIC model in the delivery of health care services. These are: 1) innovation 2) organisational governance and 3) accountability. The study adopts an exploratory and qualitative mixedâmethods approach that includes semiâstructured interviews and document analysis. Through this the thesis contributes to important debates on the role of CICs beyond the narrow confines of organisational governance and situates the phenomenon at the intersection of political, social and economic preoccupations with public service delivery. The thesis bridges the gap between the macro, meso and micro dimensions arguing that no matter how innovative CIC are, they are managed by contractual arrangements in a quasi-market system and regulated by the state. This means CICs face tensions and contradictions as they seek to balance multiple expectations and demands associated with their distinct institutional form as well as the wider context of the NHS. The thesis finds that a drive towards greater efficiency and shifting priorities in the policy environment play a crucial role in shaping conditions for innovation and change.