Power and Culture in the National Health Service

Abstract

The huge popularity of the NHS as a public institution has been matched, certainly during the last decade, by the enormity of the problems it has posed for the politicians responsible for it. Prime Ministers and Secretaries of State have wrestled with schemes for reorganising the Service, but at the time of writing it is brutally apparent that no generally accepted or well-tested solution has yet been found. In the following chapters we intend to explain why the NHS has proven so difficult to reform. We will focus not so much on ‘high politics’ as on the level where reform seems most frequently to come to grief — the month-by-month, year-by-year management of the Service. Our strategy will be to call on a very wide range of research (including some recent fieldwork of our own) in order to identify the congerie of practices, powers and perceptions which has shaped, and will continue to shape, the impact of governments’ efforts to change the NHS.