No country for old men: The rise of managerialism and the new cultural vacuum

摘要

The UK's National Health Sendce has been changed massively by refinement and expansions of complex, hierarchical, 'cascading' forms of management. These culminate in the standardised micromanagement of clinical care. Much of this derives from models from competitive corporate industry. While such intense and rigid management may eliminate some of the worst clinical practice, it may (unintentionally) prevent the best. This is most likely where flexibility; creativity and attuned imagination are required tx) enable growth and healing. New forms of service design and economy (for example, NHS Trusts and Commissioning) may work well with easily treated and clearly defined physical pathology, but are likely to be problematic, even harmful, in other healthcare areas.