The Perceptions of the NHS Managers Towards the Recent NHS Reforms and their Effects on the NHS Managerial Culture

Abstract

The last few years have seen the introduction of a raft of new NHS reforms and, as in the past, NHS managers as change agents have been given the responsibility for their implementation. The views, beliefs and attitudes of managers to such changes can therefore be considered to be paramount to the effective and successful implementation of the proposed NHS reforms. Twenty-eight managers from two Acute Care and one Community Care NHS Trusts in London were interviewed, after completing questionnaires, with a view to understanding the factors that influence and affect the "social construction of reality" of the actors involved. It emerged that managers from Acute Care NHS Trusts particularly identified Clinical Governance as being the most welcome reform and this appeared to be partially linked to the belief that it would enhance their own power by making clinicians more accountable to management through a legitimate framework. Furthermore they saw Clinical Governance as a mechanism which would allow managers to be replaced by clinicians as convenient media scapegoats. The Community Care Trust managers were more concerned with the formation of Primary Care Groups and Primary Care Trusts as this had an immediate relevance to their day to day work because of the nature of their Trust. Although generally in favour of the recent reforms these managers were rather circumspect about increased workloads. By and large the managers believed that the NHS had a pan-organisational "altruistic" culture which had been unchanged by the past and recent reforms, and although they believed that the public did not see them as being part of this culture, the managers believed that this public view was misguided and unfair. The fit between the managers’ perceptions of the recent reforms and their view of their own value system should generally have positive implications for the successful implementation of the recent reforms. If managers are to continue to support the NHS reforms it may be important that they receive acknowledgement of their contributions as well as wholehearted support from their own senior ranks, the public and from their political masters.