ABSTRACT
This chapter explores the reasons for healthcare rationing becoming a major public policy problem in the early 1990s. It focuses on what limited completed published research and other sources exist, as well as material which, though in the public domain, is not widely accessible. Management was perceived as diplomacy in which every effort was made to reach an accommodation between interested parties in matters of a sensitive or controversial nature. The inquiry team was concerned at the lack of individual management accountability in the National Health Service and, by implication, was highly critical of the system of consensus management. Managers were increasingly seen as the agents of ministers – mere functionaries in a chain of command put in place by Roy Griffiths' general management changes – rather than as a group of enablers and facilitators who existed primarily to support doctors and make their lives tolerable.
