ABSTRACT
This chapter provides an overview of some of the basic contours of these debates so that the reader can gain an understanding of where this study locates itself before detailing how managers have been co-opted into the incremental deconstruction of the NHS over several decades. The shape of the emergent NHS reflected the political challenges of its establishment; the British Medical Association, which was a fierce opponent, negotiated substantial concessions for its members. The Griffiths Report institutionalized management in the NHS, and the role of manager was to control clinical activity, budgets and performance. Organizations were rated by the newly established Commission for Health Improvement (CHI). Although national targets were subsequently abandoned, along with the star rating system, priorities continued to be indicated through the Operating Framework for the NHS, published annually. The National Institute for Clinical Excellence (NICE) was created to make decisions on the adoption of treatments.
