Who are NHS middle managers? What do they do, and why and how do
they do it'? This book explores the daily realities of working life
for middle managers in the UK's National Health Service during a
time of radical change and disruption to the entire edifice of
publicly-funded healthcare. It is an empirical critique of the
movement towards a healthcare model based around HMO-type providers
such as Kaiser Permanente and United Health. Although this model is
well-known internationally, many believe it to be financially and
ethically questionable, and often far from 'best practice' when it
comes to patient care. Drawing on immersive ethnographic research
based on four case studies - an Acute Hospital Trust, an Ambulance
Trust, a Mental Health Trust, and a Primary Care Trust - this book
provides an in-depth critical appraisal of the everyday experiences
of a range of managers working in the NHS. It describes exactly
what NHS managers do and explains how their roles are changing and
the types of challenges they face. The analysis explains how many
NHS junior and middle managers are themselves clinicians to some
extent, with hybrid roles as simultaneously nurse and manager,
midwife and manager, or paramedic and manager. While commonly
working in 'back office' functions, NHS middle managers are also
just as likely to be working very close to or actually on the front
lines of patient care. Despite the problems they regularly face
from organizational restructuring, cost control and demands for
accountability, the authors demonstrate that NHS managers - in
their various guises - play critical, yet undervalued,
institutional roles. Depicting the darker sides of organizational
change, this text is a sociological exploration of the daily
struggle for work dignity of a complex, widely denigrated, and
largely misunderstood group of public servants trying to do their
best under extremely trying circumstances. It is essential reading
for academics, students, and practitioners interested in health
management and policy, organisational change, public sector
management, and the NHS more broadly.
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