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No description available.

This study traces the evolving role of NHS doctors in management, from the early years of informal, but highly influential involvement, to the formalised and accountable positions they now occupy in management. The study attempts to assess whether doctors are "the natural managers" of the NHS and, if so, the implications of this. The associated argument, which is pursued throughout the study, is that power and authority need to be brought together in order for management to be effective and argues that the involvement of doctors in management is the only realistic way to bring this about. A qualitative research approach has been used to explore through interviews, the views, opinions and experiences of 30 key informants, including Consultant Medical staff, (many of whom occupy Medical/Clinical Director positions). General Medical Practitioners, Chief Executives, senior NHS Executive and Health Authority officials, and other health professionals. The study, which is mainly centred on the operational level in secondary care, concludes that the active, formal involvement of doctors in management does bring about the blend of power and authority which was previously missing, but no over-riding view was expressed by informants to suggest that this means doctors are "the natural managers." In order to make better use of clinical and other resources, a shared partnership in decision making at the top of the management structure between the senior doctor manager and the lay Chief Executive is required. More encouragement is needed to develop the present fragile role of doctors in management in order to secure the relatively untapped source of managerial power and authority which the involvement of doctors in management can bring about.

Despite the importance of public facilities in everyday life, as yet there is little agreement on how a theory of public facility location is to be produced. Following a review and evaluation of previous research, it is argued that public facility location should be analysed within the context of a theory of society and of the state. This in turn necessitates an assessment of alternative theoretical propositions concerning the state. Following this, an account is presented of major developments in the hospital services in the area covered by the Newcastle RHB (Northern RHA from 1974). This account discusses the nature of and reasons for the changing character of state intervention in the British economy since the war, and traces the implications of these changes for spatial aspects of hospital provision. Detailed studies are presented of disputes on local hospital strategy. This material is structured thematically so as to facilitate commenting on the role of the state. A concluding chapter summarises the empirical material, assesses the relative merits of various approaches to theorising the state, and considers the implications of this research for public facility location theory.

The re-organisation of the National Health Service (NHS) in 1974 was intended to have a profound and fundamental effect upon the decision-making underpinning the development and delivery of health care services. Re-organisation was considered necessary on two grounds: first to unite the tripartite structure of health care which had existed since 1948; and second to instil the discipline of a corporate management and planning system into the health service. By the late 1970s it had become clear that the corporate management planning system was not working; certainly not as its procreators had envisaged. The system was judged a failure on four counts: 1) health planning became largely prescriptive;2) it remained essentially incrementalist; 3) very few plans and policies produced were evaluated; and4) an inability to achieve the change envisaged. Given the perceived failure of the corporate management planning system to effect change in the NHS, the study sought to investigate two pertinent issues: firstly, the extent to which the philosophy and rationale of health planning is a guiding force leading to better policies; and secondly, to understand those factors which influence and impinge on the planning process and the resulting policy decisions. It is clear from the investigation that health planning in the NHS has failed to live up to expectations. The study has demonstrated that the introduction of a formal planning system into an organisation, however well-intended, is of itself not enough without additional and continuing support. In the local case study, mechanisms and procedures were established and adhered to, and yet very little in the way of acceptable and implementable plans were produced. Nevertheless policy changes did occur and a number of factors can be cited as explanation for this phenomenon. Leadership emerged from the study as being a crucial ingredient in any recipe for planning and policy-making. Power was another dominant factor which was generally applied in a negative sense but when used in a positive way, dramatic results were possible. The third ingredient necessary for effective planning and policy-making was involvement not only of others in the organisation but also of the public. However having these attributes is not enough and the study has demonstrated the need for a more integrated style of planning, policy-making and management, and a concept of strategic management is proffered as an appropriate vehicle for creating within the NHS the desired future change consistent with the needs of the public.

No description available.

No description available.

No description available.