Alford Revisited: The Professional Monopolisers, Corporate Rationalisers, Community and Markets

North, Nancy

doi:10.1332/030557395782453545

Cited by 11 publications

(12 citation statements)

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“…The conventional wisdom is that medical power tends to dominate in the NHS. In the 1980s and 1990s the power relations between managers, doctors, and the public remained unclear (70). It is arguable that the Griffiths management structure and the 1991 internal market reforms tilted the balance in the direction of managers (71), but in spite of much rhetoric about consumerism, patients were not empowered (70).…”

Section: Accountabilitymentioning

confidence: 99%

New Labour and the Third Way in the British National Health Service

Powell¹

1999

Int J Health Serv

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The British Labour Party claims that its policies are based on a "third way," new and distinct from both the old left and the new right. This article critically examines this claim with respect to health policy. After examining the Conservative legacy in the National Health Service and the evolution of Labour's health policy, the author introduces the concept of the "third way" and discusses the extent to which Labour's health policy can be seen in these terms, using the themes of spending, competition, accountability, and public health. There are many differences between the health policies of New and Old Labour, and some differences between those of New Labour and the Conservatives. Indeed, to a large extent Labour's health policy is built on the legacy of the Conservatives and is characterized by evolution. It is difficult to find any "big idea" or coherent philosophy behind the third way. Rather than being a new and distinctive approach rejecting both the old left and the new right, it seems to be a pragmatic pick and mix, attempting to combine the best from the market approach of the Conservatives and the hierarchical approach of Old Labour.

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Section: Accountabilitymentioning

confidence: 99%

New Labour and the Third Way in the British National Health Service

Powell¹

1999

Int J Health Serv

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“…Alford (1975) interpreted health care politics as a tension between dominant (professionals), challenging (managers) and repressed interests (community). This categorisation is now considered "a somewhat inflexible template when fitted against the complexity of internal markets" (North, 1995). Moreover, the thesis is disputable because managers do not always challenge professionals but often collude with them to avoid conflict and/or maintain the status quo (Hunter, 1991;Hunter, 1992).…”

Section: Policy and Conceptual Backgroundmentioning

confidence: 99%

Clinical Audit in the NHS internal market: from peer review to external monitoring

Exworthy

1998

Public Policy and Administration

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Relations between managers and professionals in the public sector have often centred on the control of work performance. Work performance strategies and techniques have been transformed by recent public sector policies involving managerialisation and quasi-markets. In particular, the clinical audit programme in the National Health Service has traditionally been the preserve of professionals, mainly doctors but managers and purchasers have become more involved recently. Based on an empirical study, this paper explores the ways in which Health Authorities were approaching their responsibilities, the consequences of such strategies for purchasers and providers, and the implications for professional-managerial relations. The paper concludes that purchasers have not made substantial progress in assessing work performance because ofprofessional resistance and the non-threatening environment fostered by some purchasers.

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“…Less academic interest, however, has been shown in operational relationships between health authorities and trusts and in the way managers in both types of organisation would operate in a changed political environment. In an earlier paper (North, 1995) I suggested that previous conceptualisations of post-Griffiths managers, which tended to clone them as 'corporate rationalisers' committed to a broad set of goals, were too simplistic for an NHS fragmented by purchaser or provider loyalties. In discussing the micro-politics of local commissioning such differences are important.…”

Section: Espanalmentioning

confidence: 99%

Implementing Strategy: the politics of healthcare commissioning

North

1998

Policy &Amp; Politics

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EnglishThe purchaser-provider division in the National Health Service was intended to enable informed purchasers -general practitioner (GP) fundholders and district health authorities (DHAs) -to improve the cost-efficiency and quality of healthcare provision. Competition, or the threat of it, would encourage compliance from hospital and community trusts which previously had been protected by routinely provided resources. Although much attention has been given to the performance of GP fund holders, rather less interest has been paid to the activities of DHAs, whose task is qualitatively and quantitatively different from that of our GP purchasers. Drawing on research undertaken over a IS-month period, this article analyses a DHA's attempts to implement a purchasing strategy. It uncovers several factors contributing to the strategy's slow progress and concludes that factors constrained the DHA's ability to achieve strategic changes in an important service area.

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Alford Revisited: The Professional Monopolisers, Corporate Rationalisers, Community and Markets

Cited by 11 publications

References 0 publications

New Labour and the Third Way in the British National Health Service

New Labour and the Third Way in the British National Health Service

Clinical Audit in the NHS internal market: from peer review to external monitoring

Implementing Strategy: the politics of healthcare commissioning

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