Headlines: October 9th, 1997

Turning the NHS Executive into an independent corporation is an option considered by successive Secretaries of State. After a one year study into the developments of governance of the NHS and the structure of the Department of Health, Patricia Day and Richard Klein of the University of Bath have concluded that radical change would be needed first if such a goal were to be achieved. The study, which is part of the Economic and Social Research Council Whitehall Programme, found that two cultures are at the heart of the management of health care in the United Kingdom.The NHS Executive is made up mainly of former NHS managers. The culture is distinctly ‘managerial’ with the emphasis on risk taking, centred on the NHS and outcome oriented. The Department of Health civil servants belong to the mandarin culture where risks are avoided, it is centred on ‘the Minister’ and the emphasis is on the process, rather than the outcome. Civil servants prefer to manage by the written word and however results are achieved the paper work must be in order because the shadow of public accountability lies heavily on them.

There is evidence of convergence between the two cultures. Forces are at work pulling managers towards the Minister centred culture of the civil service. Similarly, the civil service mandarins are being pushed towards greater managerialism by the desire of Governments of whatever party to squeeze ever more outputs from ever more constrained budgets. Although these trends are continuing, they will not be sufficient to pave the way for making the NHS Executive an independent corporation. Other innovations relating to funding and accountability must be sought first.

A full summary of the findings are given in the Features Page see – Steering but not rowing – Transformation of the Department of Health.