ABSTRACT
The NHS and Community Care Act has had an enormous impact on the health service, social services and voluntary organizations through the creation of a purchaser/provider split and the need for contracting arrangements. To quote Simon Biggs:
As one would expect from a method rooted in the free enterprise culture of the US and the project to turn the British Welfare State into a mixed economy, case management assumes a marketplace model of interpersonal relationships—that is to say a meeting of two equal individuals coming together to agree a bargain on the exchange of goods and services. This guiding principle is interesting from a psychodynamic point of view, largely because of the detail of interpersonal thought feeling and action it leaves out. It proposes a vision of single persons rationally in possession of relevant information and a cool grasp of their own motivation, finding an agreeable solution to a mutually agreed definition of need.
(Biggs, 1991:73; see also Chapter 6) So what are the consequences in terms of the services of the public sector? And in particular, how are the managers in the various organizations coping with and making sense of this new culture? My sense of some of the issues emerging for public sector managers can be illustrated by reference to an example drawn from some consultancy work that I undertook with a large NHS Trust.