Reorganizing the NHS: Theory and Practice

Given that the objective of the book is to consider some of the more theoretical issues involved in managed social change, using the example of the introduction of general management in the NHS, it is appropriate to set this example in its proper context. Specifically the chapter documents, firstly, the attempts to reorganize the NHS prior to the introduction of general management and, secondly, what is known about the effects of these attempts. The chapter begins by discussing the emerging concerns about the way in which health services were developing after the formation of the NHS, the build up to the first reorganization in 1974, and the core features of that reorganization. It goes on to explore pressures leading up to the second reorganization in 1982. A central question to be addressed concerns the issue of why the two reorganizations of the NHS, prior to the introduction of general management, took an essentially bureaucratic form. The final section of the chapter focuses on management within such a structure, and briefly reviews the available ethnographies of management of local health services and the more general literature on health service management until 1983.