MANAGERIALISM IN HEALTH CARE SERVICES

Does managerialism in health and social care services present more challenges to frontline managers than opportunities?

Does managerialism in health and social care services present more challenges to frontline managers than opportunities?

The term 'managerialism' is closely associated with new public management (NPM), which has generally been described as representing a paradigm shift in the values and priorities in public sector organizations: from an essentially needs-driven approach to public policy and provision to one that is largely resource driven. The roots of public sector managerialism lay in 'new right' politics, coming to prominence in the mid-1970s, which advocated business thinking and entrepreneurialism within government and public services to drive out waste and increase efficiency. Managerialism has passed its 'high point', but a strong legacy remains and, in some quarters, including probation, it is really only now that the full impacts of the associated value shift are beginning to be felt.

Since the 1970s many countries have recognized that they need to contain health care costs, improve performance and outcomes and make their services more user-sensitive and have turned to management as the solution (Hunter, 1996). In place of an administrative approach where managers 'oiled the wheels' in consultation with other health care workers, an industrial model of management has been introduced, regardless of its relevance or appropriateness for public services like health care.

The emphasis now is on managers taking control, setting performance targets and imposing budgetary and workload ceilings. This approach has set managers on a collision course with other health care professionals such as doctors because of these professionals' claim to autonomy. In this entry the development of what has been called 'New Public Management' (NPM) in Britain is briefly described and the implications for social relations in health care and, in particular, for relations between managers and doctors, are considered.

It is possible to see the development of NPM in Britain as involving two elements: challenging professionals in the health service and incorporating them (Harrison and Pollitt, 1994). Each will be considered in turn. Challenging health service professionals involves subordinating professional autonomy to managerial will, an approach first adopted in 1983 with the introduction of frontline managers into the National Health Service (NHS) as recommended in the Griffiths Report. Prior to this report NHS managers, or as they were then called, administrators, acted as diplomats, helping to organize the facilities and resources for professionals to get on with their work and reacting to problems as they arose. Decisions were made consensually by multi-disciplinary teams that included doctors and nurses, as well as administrators.

In Scotland, the internal market was abolished and regional health boards were established in April 2004. Although the policies and structures between NHS Scotland and England diverged (the purchaser-provider split was maintained in the NHS in England), NHS Scotland nonetheless also incorporated performance assessment frameworks. In NHS Scotland efficiency and effectiveness was to be ensured more through the use of performance assessment frameworks than a ...