ABSTRACT
A constant theme running through successive reorganisations of the NHS since the mid-1970s has been the search for improved management. The search has been accompanied by growing centralisation, with occasional lapses into decentralisation and the application of market principles to the delivery of care (Hogget 1991; Hunter 1994). As Hoggett observes more generally in the restructuring of the public sector in Britain, elements of decentralised, hands-off, market-based approaches to delivering public services have been ‘dwarfed by visible elements of centralization . . . and the extended use of hands-on systems of performance management creating a form of “evaluative state” ’ (Hoggett 1996).
