Deconstructing the Welfare State

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.