ABSTRACT
The Francis Report outlined the way a group of staff had systemically become detached, cruel, and disengaged from their responsibilities. In this chapter, the author outlines some theory that he has found useful when thinking about clinical care and clinical institutions, before going on to examine some of the features of the current system. He then focuses on the fragmentation of the authority and support for staff in front-line clinical posts and problems in training that leave nurse without a sufficiently robust professional identity. The internal market, introduced early in the 1990s, has created an increasingly fragmented healthcare system as different parts of the system are encouraged to compete for patient contracts, rather than work together in the interests of the patient. The target culture and National Health Service (NHS) Trusts' anxieties about survival have created a top-down management system that pushes anxieties about survival down the hierarchy into front-line clinical staff.
