MANAGING PUBLIC SERVICES NHS

Managing public services NHS



Managing public services NHS

Introduction

The public sector has long been subjected to criticisms for, among others, inefficiency, red tape, lack of flexibility, ineffective accountability and poor performance. Such criticisms have paved the way for administrative reforms and reorganizations seeking to address various administrative ailments and enhance the efficiency and performance of public bureaucracies. With changes in time and circumstances reform agenda has varied, but reforms have always been seen and applied as a means to bring about desired changes in administration and improve its capacity as well as performance.

This paper explores future leadership requirements for the UK NHS in the context of relevant leadership theory and the changing environment for health services. It argues that insufficient attention has been paid to the development of external leadership for health services, the demands of which will increase in future years.

Discussion

The UK National Health Service (NHS) is one of the largest organisations in the world and the largest in the UK. Its estimated budget for 1998-1999 is some £46 billion and it employs almost one million people. Established in 1948 by the post-Second World War Labour Government, it was the first health system in any Western society to offer free medical care to the entire population: it was intended to be universal in coverage, comprehensive in terms of services provided, available on the basis of clinical need and divorced from the ability to pay. Financing the new NHS, via taxation and insurance contributions had hardly begun before there was a funding crisis, leading to the introduction of prescription, dental and ophthalmic charges and the consequential resignation of the first Minister of Health, because of his opposition to their introduction. The purity of the socialist conception of health care was lost and two issues have dominated the UK NHS ever since:

•financial resources; and

•politics.

Apart from a structural change in 1974, when community nursing, therapy and public health services were transferred from local government control to the NHS, the 1948 administrative framework remained the same until the early 1980s when a number of major changes commenced. The election of Margaret Thatcher's Conservative government in 1979 led to a reduction in the size and role of the public sector and the introduction of strategies to improve the delivery and efficiency of public services. Four broad features of the changes have been identified (Ferlie et al., 1996; Mellon 1995):

•a privatisation programme;

•the introduction of managerialism, particularly based on internal or quasi-markets;

•an increased emphasis on efficiency; and

•a move from maintenance management to the management of change with greater leadership of the public services.

These changes have not been limited to the UK (Hood, 1991) and the new public management agenda, as the changes have been labelled, have been pursued by other countries.

General management introduced

The NHS Management Inquiry (DHSS 1983) resulted in the first significant departure from the 1948 administrative system with its emphasis on decision making by consensus. The inquiry, or Griffiths Report as it is more popularly known, gave advice ...