ABSTRACT
The concept of a medical consultant who is also managerially responsible for the running of a unit is nothing new. The medical superintendent role was created before the NHS came into being, only to be replaced by administrative staff as major decision making passed to district and regional health authorities. Consultants had considerable autonomy when organizing their individual work practices, both inside and outside the hospital, but at a hospital level, administrators controlled day-to-day affairs. Many services changed and grew according to the enthusiasms and skills of individuals rather than in response to either public demand or health need.
