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Organisational Changes Within the National Health Service

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Organizational Changes within the National Health Service

1 . Discuss and debate the organizational changes within the National Health Service and examine how these have influenced care delivery

At the start of the NHS , a mediation model of management subsisted where the role of the manager facilitated health care professionals to care for the patient . Medical staffs were extremely influential and controlling in determining the shape of the service , at the same time as managers were imprudent and focused on managing internal organizational

issues (Harrison et al . 1992

After the 1979 general election , there was originally little change to the National Health Service (Klein 1983 . Though , poor economic growth together with growing public expenditure , slowly brought about changes Influenced by the 'New Right ' ideologies , a more interventionist practical , style of management in the health service emerged . This efficiently changed the role of managers from one of imprudent scapegoats for existing problems , to agents of the government (Flynn 1992 . Managers became the means by which government control over NHS spending was increased (Harrison and Pollitt 1994

The impulsion for this change arose from the 1983 Griffiths report (NHS Executive 1983 , an assessment by the government health advisor , Sir Roy Griffiths . Within this report , four specific problem areas were recognized : the limited management influence over the clinical professions a managerial stress on reactivity to problems the significance placed on managing the status quo and a culture of producer , not consumer , orientation (Harrison et al . 1992

The power of the Griffiths Report (op . cit ) was to challenge and limit medicine 's sovereignty in the health service , and over health care resources . certainly , nurses were simply referred to twice throughout the document . Through its attention on organizational dynamics and not structure , the Griffiths Report proposed main change to the health service . General Managers were initiated at all levels of the NHS . In spite of Griffiths ' original intention that it was simply cultural adjustment that was required , there were instantaneous and considerable structural and organizational changes in the health service (Robinson et al . 1989 . Post-Griffiths there were escalating demands for value for money in the health service (DoH 1989 . Efforts to extend managerial control over professional autonomy and behavior so continued throughout this intense period of change , and terminated with the NHS and Community Care Act (DoH 1990

From the re-organizations that taken place during this period , the NHS was rationalized to conform more intimately to the model of free enterprise in the private sector . This reformation was shaped by the belief that greater competence could be stimulated through the formation of an internal and competitive market . The belief that the health service was a distinguishing organization was disputed . The principles of economic rationality linked with business organizations were applied extensive to the operation of health service . The services requisite were determined , negotiated , and agreed by purchasers and providers through a funding and constricting mechanism . In this , trust hospitals and Directly Managed Units supplied health care provision for District and...

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