ABSTRACT
In this chapter changes in the nature of the professions that contribute to the NHS and changes in the organisations they work within are considered. There is an emerging dynamic between bureaucratisation and commodification that impacts on structures, on practice and on the ethics that guide organisational practice in the Welfare State. In addition, neoliberalism impacts on the professions that make key contributions. The chapter examines how medicine and nursing have been changed. The latter part of the chapter combines an interest with organisation and with professions by looking in more detail at the changing structures and operational practices of managers in the NHS. It considers the assumptions of New Public Management ideas that ally with neoliberalism and that achieved an ascendancy in the NHS and it looks at the emergence and spread of hybrid managers. These are members of the health professions who take on managerial roles. Are they protecting priority setting based on clinical concerns from cost-cutting, profit maximising, organisations or do they offer a route to exercise more effective control over the health professions in the interests of market economics?
