The Frontier of Control

Abstract

For more than three decades now, the National Health Service (NHS) has been obsessed with notions of ‘better management’. Indeed, most commentators are in favour of better management in much the same way as they might oppose sin: as a truism. The sceptical observer, faced with this knowledge and yet seeing the NHS in the throes of yet more managerial reforms, is entitled to ask what, if anything, is different about the Griffiths innovations and other contemporary changes? Chapters 2, 3, and 4, of this book attempt to answer that question by comparing changing conceptions of the desirable role of the NHS manager before and after 1982; the conclusion which is reached is that these recent changes represent the first serious attempt, in the lifetime of the NHS, to shift the ‘frontier of control’ between, on the one hand, doctors (physicians), and, on the other, the government.