AGENCY AND ROLE PAPER

Agency and Role Paper

Agency and Role Paper

NHS and its relation to public health agencies

Throughout its short history the NHS has been subject to numerous reforms and reorganizations. Over the last 12 years change has come upon the service more quickly and more profoundly than ever before (Astley & Van de, 1983, p.245-273).

These changes in methods and procedures considerably affect the lives and work of NHS employees. This holds chiefly in the NHS where, before the introduction of general managers, professional heads had the responsibilities for employment, development and disciplining of their staff (NAHAT, 1994; Strong and Robinson, 1990). However, as in many organizations, a change in orientation toward customer care, quality initiatives and competitiveness, has placed line managers in the forefront of cultural change (Poole and Jenkins, 1997).

There has recently been an emphasis at the NHS on "putting patients first" (Department of Health, 2005). To achieve this, local trusts are encouraged to adopt a "best business practice" approach by "engaging all staff" through people management processes. Our research at Manchester Business School, sponsored by the Department of Health, the CIPD, and the Healthcare People Management Association, aims to explore how HRM can contribute to improved performance in the NHS (Chow, Teknika, Williamson, 1998, p 263-280).

This new ideology of governance of the NHS has changed dramatically, especially through the Thatcher administration. Harrison (1997) describes how there are three ways of co-ordinating the activities of a multiplicity organisation, through markets, clans and hierarchies. Clans and hierarchies are based on using the process of co-operation to produce an ordered system of outcomes. The historic NHS was built very much around them; a combination of bureaucracy and professional culture; labelled as ‘professional bureaucracy’ by Pugh and Hichson (1976). The new NHS is now reflected as having a market orientated organisation.

NHS's function

The National Health Service or NHS as it is more commonly known was set up on the 5th July 1948 to provide healthcare for all citizens, based on need, not the ability to pay.

The NHS is mainly funded by the tax payer and run by department of health which sets specifications and guidelines on health issues(Secretary of State for Health , 2000, pp.231).

It was launched as a single organization based around 14 regional hospital boards(see Appendix II for NHS Organogram). This new NHS was originally split into three parts: hospital services family doctors, dentists, opticians and pharmacists local authority health services, including community nursing and health visiting. In 1948, NHS went through a drastic change in respect to the organizational structure and in regard to the services provided to the patients. This was a monumental task to make health services available to all citizens which mainly fell into the system of public finance and public provision (NHS Executive , 2000, pp.112).

Two key factors that governed NHS was that there should be equal basis to treatment for all based on clinical needs regardless of patients monetary circumstances. Secondly, collective funding of NHS through national taxation is the most effectual way to ensure that ...