ABSTRACT
Health and welfare services traditionally combine the professional and bureaucratic forms, with the professional strategy being stronger in health services and the bureaucratic form being stronger in local government. From the 1970s onwards many organisational sectors have attempted to subdue professionalism through the use of bureaucratic control strategies. Changing the structure of an organisation is not necessarily the best way to improve performance. All organisations balance local and central management control in some way. To run an effective organisation, a variety of 'management support functions' must be served. These are the functions that are not concerned with service delivery or the management of the service itself, but are necessary for management to draw upon to work effectively. The decisions are likely to be made by higher levels of the organisation, but there may be some scope for choice of arrangements. Some organisations centralise these functions more than others, and overcentralisation can impair organisational effectiveness.
