The Restructuring of Welfare Work: The Introduction of General Management and the Contracting out of Ancillary Services in the NHS

This paper examines recent attempts by the state to restructure welfare organizations by the introduction of market rationality and criteria into the NHS. The paper consists of two case studies of the implementation of recent government policies. The first case study discusses the initial effects of the introduction of new management arrangements based on private sector principles (the Griffiths Report), and the second examines the political imposition of a programme of contracting out ancillary services in the NHS. Both case studies draw on research carried out by the author in two district health authorities. The case studies illustrate the nature of the `political contingencies' operating on managers, workers and trade unions within the NHS. It is argued that attempts to introduce forms of market rationality in the NHS have undermined and obscured the purposes of state welfare work and have produced a number of tensions and problems for managers which have further to be resolved. Evidence from the research also suggests that these recent policies have begun to change the terms, conditions and security of employment for both general managers and ancillary workers.