The Operation of the Service

Abstract

For a structure as complex as the National Health Service to be effective it is essential to define and adhere to a delegated decision-making process appropriate to the various functional levels. Within a health authority’s own domain fairly clear levels of decision-making can be identified. The first is the overview or initial broad allocation of resources between programmes of care which determines the growth or containment of particular services. The second is units and the services themselves, for example community services or various groups of hospitals, where particular components can similarly be encouraged or discouraged in attempts to achieve a balance or redistribution of resources; indeed, depending on the size of separate budgets, the process of redistribution may with advantage be further refined where parts of services within particular sectors may be identified for the augmenting or curtailing of available resources. Finally, there are the individual teams of health-care workers who by their day-today decisions and adoption of practices commit not only the resources immediately at their disposal but, and often unwittingly, developments for the following and subsequent years.