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Outline organisational structure of English (and Welsh? - PB) NHS, 1985. From https://www.sochealth.co.uk/national-health-service/griffiths-report-october-1983/national-health-service-management-in-the-1980s/


THE IMMEDIATE EFFECT

Harrison finishes by suggesting that actually Griffiths' reforms had little immediate effect. Discussing a survey conducted in two different District Health Authorities (one in London and one in the North) he says: 'Few of the respondents in either district held the view that, in general terms, the introduction of general management had led to any substantial shift in the balance of influence between managers and doctors.' To quote another source: '“The NHS has such a strong culture, and a range of subcultures, and I think Griffiths probably underestimated that. I worked with two general managers who had come in from the private sector, one from Unilever and one from Metal Box, and they both left after about a year and a half because they couldn’t cope with the clinicians, particularly medics, not doing what they said they would."' Mike Cooke, in 2014 chief executive of Nottinghamshire Healthcare Trust, quoted in Claire Read: The Future of NHS Leadership: unpicking Griffiths' complex legacy, https://www.hsj.co.uk/future-of-nhs-leadership/the-future-of-nhs-leadership-unpicking-griffiths-complex-legacy/5072855.article).

Since the main concern was cost cutting, it certainly didn't work to the benefit of patients. Harrison quotes one Ward Sister in the Northern District Health Authority: 'A patient is the last person that managers can think about. My ward was temporarily closed to save money and the nurses felt so guilty and aimless that they had to be counselled by the hospital chaplain.' Or a consultant surgeon in London: 'Our unit managers can’t worry about patients. All they can do is balance the books.'

So budgeting was the major area in which here was an immediate effect:

'doctors were increasingly aware that managers would detect "creeping developments": changes in clinical practice – whether in terms of ‘hardware’ such as more expensive prostheses, or practices such as admission policies – which had financial consequences for the organisation visible to managers only in retrospect. Doctors’ perceptions of managers’ concerns in this area, combined with slowly improved information and budgeting systems, led many to be more circumspect than before and to consult managers in advance of changing practice. It was no longer easy to obtain even relatively small amounts of money by informal means, even though consultants in Northern District Health Authority retained the right of direct access to the District General Manager:

'I can’t take the administrator out for a beer and get a new cystoscope anymore (Consultant Neurologist, Northern DHA).'

But probably the most important consequence of the Griffiths reform was that doctors no longer possessed sovereignty within the NHS. As Harrison points out, doctors enjoyed a high level of public support and respect, while administrators and managers - 'bureaucrats' - were regarded with disdain (and this was of course part of the Thatcher ideology). Fowler had been reluctant and slow to announce the transfer of power to general management as Government policy. So even if the effects were not felt immediately it was a shift in culture that prepared the way for the next major development, the introduction, under Kenneth Clarke as Secretary of State for Health (1988-90. The Department of Health was newly separated from Social Security) of the 'producer-purchaser split' - the introduction into the NHS of a fake 'internal market.'

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