ABSTRACT
This chapter explores managerial work at our second NHS trust, 'Combined Counties Ambulance Service NHS Trust' (CCAS). It explains in particular on the daily working lives of junior and middle managers across three distinct parts of the service. The chapter focuses on the themes of intense work pressure amid a quite strongly entrenched uniformed culture and demonstrates how organizational change is contested and complicated. It provides a brief overview of the historical and contemporary backdrop to UK ambulance services in order to contextualize what CCAS does, the problems it faces, and how it is trying to adapt and modernize to face increasingly complex and challenging environments. It explains the combined effects of these phenomena created a strong impetus towards reproducing the norms and features of CCAS's traditional uniformed and emergency-focused organizational culture. This section explores the relationships between managers and front-line staff in more depth, focusing in particular on the contentious issue of organizational culture.
