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By Jonathon Gabe

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In a survey conducted recently to find out whether members of the public would prefer doctors, managers or politicians to determine priorities in health, the majority put their faith first in hospital consultants (61 per cent), then in GPs (49 per cent) and finally in managers (22 per cent) (Heginbotham 1993). Nor is it only members of the general public who are culturally predisposed to accept the authority of doctors. Most groups of health service workers are similarly deferential though this may be lessening, as in the case of managers imbued with the ‘Local Voices’ (NHSME 1992) philosophy of involving the public in decisions about which treatments should take higher priority.

A greater degree of corporatism may be the outcome. First, there is the effect of the NHS reforms. The purchaser-provider split has required providers to market their services and become more customer-oriented. Hospitals with trust status cannot assume that business will automatically fall to them if the price and quality of care are unsatisfactory. As a result, they are having to evolve a corporate culture which can only succeed if doctors are a central part of it. As the survival of the hospital may be at stake there are strong externally derived pressures on doctors and managers to sink any differences which may exist between them and to act together to ensure the long-term viability of the services being provided.

London: Chapman & Hall. , Marnoch, G. and Pollitt, C. (1992) Just Managing:Power and Culture in the National Health Service,Basingstoke: Macmillan. Heginbotham, C, (1993) Healthcare Priority Setting: A Survey of Doctors,Managers and the General Public,London: King’s Fund College. Hoffenberg, R. (1987) Clinical Freedom,London: The Nuffield Provincial Hospitals Trust. Hoggett, P. (1991) ‘A new management in the public sector’, Policy and Politics,19 (4): 243–56. Hood, C. ’, Public Administration,69: 3–19.

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