The effect of new public management on intensive care unit staff
The NHS is largely dependent on two groups of professionals – medics and nurses. Recent government changes support the development of a central role for management. The impact of these changes on the roles and relationships of those working in the NHS must be understood in light of the structures already in place within it. Medical dominance in healthcare decision‐making, nursing power emanating from the strength of the medical‐nursing relationship and the hierarchies within and between the two professions all affect and are affected by recent management changes. In intensive care a key feature of the context, insularity, had already significantly modified these structures prior to recent reforms. This paper starts by discussing and contrasting the response of medics and nurses to these changes before highlighting the differences in the way these changes have impacted on staff in intensive care. Analysis is based on data from an observational study of the formation of a new directorate and interviews with senior nurses, medics and managers in intensive care.
Nurses and the prospects of participative management in the NHS
In many ways the management of public services is a different type of activity from management in most parts of the private sector. Because of the character of the relationship involved in the actual provision of public sector services, which is in most instances quite unlike that involved when services are supplied on the open market, management has grown up in response to quite different problems and pressures and takes quite different forms (Ackroyd et al. 1989). Moreover, the patterns exhibited by public sector management can be seen to be just as viable and efficient in their own context as private sector management often is when it coordinates and directs the supply of goods to the market. If this is so, it would be wrong to assume that the management found in public sector services is, or still less should be, an imitation of management in the private sector. Equally erroneous is the idea that the development of management must necessarily imply the extension of the market, privatization and the elimination of public service as traditionally understood (Hindess 1987).
Management, Competition and Professional Practice: Medicine and the Marketplace
SUMMARY 
 
Within the context of the creation of the internal market for health care, the paper examines the role of clinical directors, that is doctors who have retained their professional clinical positions whilst at the same time assumed roles as managers within increasingly well-defined corporate organizations providing health care. This represents considerable change from previous contexts in which doctors could always contract out of difficult managerial decisions. The role of clinical director is examined in terms of its own directorate and its involvement in contracting, co-operation and competition both within its own corporate organization and within the wider market place for health. Key issues are raised for the individuals and organization by these changes, they are discussed in terms of time, succession, managing colleagues, financial and human resources, market behaviour, support and terms of reference. These changes occasion wider discussion in terms of the challenge of coping with future demands for innovation, changes in the distribution of power within an emerging market for health care and the relationship among health care organizations, professionals and lay clients.