By Jonathon Gabe
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Extra resources for Challenging Medicine
In particular, they endeavour 6 FROM TRIBALISM TO CORPORATISM to ensure that doctors are held accountable for their actions in a way not countenanced in previous NHS reforms. Much of the impetus behind the 1989 reform proposals, subsequently enacted through the 1990 NHS and Community Care Act, can be seen as an attempt to secure a shift in the balance of power between doctors and managers in favour of the latter. They seek to achieve such a shift in the context of advocating improved efficiency in the use of resources and in the provision of services.
1993) Effective Purchasing for Health Care: Proposals for First 5 Years,Leeds: Nuffield Institute for Health. P. A. (1988) Care of the Elderly:Policy and Practice,Aberdeen: Aberdeen University Press. , Packard, T. and Buxton, M. (1993) Medical Audit: Taking Stock,London: Brunel University and King’s Fund Centre. Klein, R. W. B. (eds) The Changing Medical Profession: An International Perspective,New York: Oxford University Press. et al. (1978) The Working of the National Health Service,Royal Commission on the NHS, Research Paper No.
Day and Klein (1983) succinctly expressed the changed approach to managing the NHS in the following terms: [as a] move from a system that is based on the mobilisation of consent to one based on the management of conflict—from one that has conceded the right of groups to veto change to one that gives the managers the right to override objections. (Day and Klein 1983:1813) CHALLENGING MEDICINE 5 But, if the Griffiths management revolution in the NHS (with echoes elsewhere in the public sector, which was being similarly subjected to the cult of managerialism) was intended to shift the balance of power, little evidence for it could be detected during the latter half of the 1980s.