ABSTRACT
The British National Health Service was founded in 1948 as part of a broad programme of post-war social reconstruction. While continuing to be widely popular, the service has invariably suffered from underfunding and regional and sector disparities in resources. Over the last twenty years, health-service organization has become a major focus of policy and public discussion in which concern about resources has been countered by an accelerating search for organizational and managerial solutions. Major organizational changes were introduced in 1974 (DHSS 1972), 1982 (DHSS 1979) and, following the Griffiths Report (DHSS 1983), in 1984. It is this Report, introducing ‘general management’, that will be discussed in more detail in this Chapter. The post-Griffiths structure had barely settled down before the Conservative government published a new White Paper in March 1989 (Department of Health 1989) proposing yet more radical changes.
