ABSTRACT
Since the early 1980s, we have been living with a dominant ideology of neoliberalism. It tells us of the imperative for markets and stresses a different kind of relationship between state and individual. Neoliberalism has impacted on the structures and scope of the welfare state and of the NHS. A generation of workers in the UK have only known neoliberalism. Its attitudes about individualism and concomitantly about the social contract have impacted on the way they undertake their jobs. This chapter begins by describing reports that looked into failures of care in the NHS: in Mid-Staffordshire Hospital; in the implementation of the Liverpool Care Pathway for end-of-life care across the NHS; and in maternity care in the Shrewsbury and Telford Hospitals Trust. These reports concluded that something had gone wrong with institutional culture and that making significant and lasting change required a change in that culture. The chapter describes how the remainder of the book will examine if the problematic culture is linked to the cumulative impact of neoliberalism on service provision.
