Health care is not immune...
to the fads and fashions of management consultancy
- ‘managerialism’ or ‘New Public Management’
- loss of clinical autonomy, increased central government controls, tensions between the management of care and the delivery of care.
- "In the health-care field, for instance, researchers in two studies involving 571 hospitals found that patient mortality rates increased by 400 percent when staffs were reduced by 7 percent…"
Health-care in many, if not most countries, is a combination of private and public sector activity, with the balance varying depending upon the political ideology prevailing at any time. In the USA, for example, the private sector is much more dominant than it is in the UK, where the National Health Service, although far from perfect, is regarded by the population at large as one of the main achievements of the Labour government of 1945 and where attempts to privatise are strongly resisted. The attempts continue, however, and the Thatcher and Major governments of the 1980s and 1990s made vigorous attempts to create a private-sector ethos, through artificial forms of competition.
Under NPM, there is an elaboration of explicit standards and measures of performance in quantitative terms that set specific targets for personnel, an emphasis on economic rewards and sanctions, and a reconstruction of accountability relationships. It promotes a reduction in scope for ministerial discretion in the administration of government agencies, it separates the funding agencies from providers of services as well as separating advisory, delivery, and regulatory functions. NPM introduces accrual accounting, capital charging and a distinction between the state’s ownership and purchasing interests. There has been a decentralization of management control towards what is often referred to as the doctrine of self-management. In the interests of so-called productive efficiency then, the provision of educational services has been made contestable; and, in the interests of so-called allocative efficiency, state education has been marketised and privatised.