ABSTRACT
O utside Bethlem, which was part of the Special Health Authority (SHA), the 1982 National Health Service (NHS) reorganization was an admission that earlier reforms had not been effective. Where it brought immediate changes the ambition of efficient management became a constant concern, sponsoring further developments not restructuring. Reorganization was followed by a drive to bring the perceived efficiency of the business world into healthcare. Sir Roy Griffiths, a governmental adviser from the Sainsbury's food chain, was appointed to look into the NHS's management structure. In the SHA, doctors felt that such business ideas were illsuited to clinical services and worried that patients would not be put first. Griffiths concluded that 'if Florence Nightingale were carrying her lamp through the corridors of the NHS today, she would almost certainly be searching for the people in charge'.l He recommended the need for a clear management structure where clinicians would be more closely involved through a unit administration. The Report also suggested the need for general managers to ensure that decisions were made.2 Griffiths's ideas were not new and had been anticipated by Leslie Paine, the Joint Hospital's second House Governor, and by the King Edward's Hospital Fund in 1967. The SHA was cautious, believing it had already carried out most of the Report's suggestions. The Management Team of Officers (MTO) feared that the 'appointment of general managers may introduce into the organisation and administration of Health Services an element of autocracy that we would see as unacceptable,.3 However, the SHA did support the idea of extending doctors' management role.
