The New Managerialism and Public Service Professions: Change in Health, Social Services and Housing

225 Pages·2005·0.72 MB·English

by  Ian Kirkpatrick

The New Managerialism and
Public Service Professions
Change in Health, Social Services and Housing
Ian Kirkpatrick, Stephen Ackroyd
and Richard Walker
The New Managerialism and Public Service Professions
The New Managerialism and
Public Service Professions
Change in Health, Social Services
and Housing
Ian Kirkpatrick,
Stephen Ackroyd
and
Richard Walker
© Ian Kirkpatrick, Stephen Ackroyd and Richard Walker 2005
Softcover reprint of the hardcover 1st edition 2005 978-0-333-73975-4
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First published 2005 by
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Library of Congress Cataloging-in-Publication Data
Kirkpatrick, Ian, 1965–
The new managerialism and public service professions :
change in health, social services, and housing / Ian Kirkpatrick,
Stephen Ackroyd, and Richard Walker.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-333-73975-4 (cloth)
1. Public welfare administration–Great Britain. 2. Social work
administration–Great Britain. 3. Health services
administration–Great Britain. 4. Public housing–Great
Britain–Management. I. Ackroyd, Stephen. II.Walker, Richard M.
III. Title.
HV245.K57 2005
362.941(cid:118)068–dc22 2004053756
10 9 8 7 6 5 4 3 2 1
14 13 12 11 10 09 08 07 06 05
Contents
List of Tables vi
List of Abbreviations vii
Preface viii
1. Introduction 1
2. Professions and Professional Organisation in UK
Public Services 22
3. Dismantling the Organisational Settlement: Towards
a New Public Management 49
4. The National Health Service 76
5. The Personal Social Services 103
6. Social Housing 127
7. Conclusion: Taking Stock of the New Public
Management 154
Notes 181
References 183
Index 207
v
List of Tables
1.1 Total UK Managed Expenditure on Health, PSS and
Housing 7
1.2 Expenditure on Health, PSS and Housing as a
Proportion of UK Gross Domestic Product 8
1.3 Total UK Managed Expenditure on Health, PSS and
Housing in Real Terms 10
1.4 UK Public Sector Employment in Health, Social
Services and Housing 1979–2002 11
6.1 Local Authority and Housing Association Stock
Holdings in England 1971–2000 132
7.1 Comparative Analysis of Policy in Three Sectors 162
7.2 Comparative Analysis of Professional Organisation 172
vi
List of Abbreviations
AHA Area Health Authority
ALMO Arms Length Management Organisation
BMA British Medical Association
CCETSW Central Council for Education and Training of Social
Work
CHA Community Health Authority
CHI Commission for Health Improvement
CIH Chartered Institute of Housing
CIPD Chartered Institute of Personnel Development
CCT Compulsory Competitive Tendering
DGA District General Hospital
DHA District Health Authority
DoE Department of Environment
FE Further Education
GDP Gross Domestic Product
GNP Gross National Product
GP General Practice/Practitioner
HIP Housing Investment Plan
HT Health Trust
LSVT Large Scale Voluntary Transfer
MBA Master of Business Administration
NFHA National Federation of Housing Associations
NHS National Health Service
NICE National Institute for Clinical Excellence
NPM New Public management
OECD Organisation for Economic Co-operation and
Development
Ofsted The Office for Standards in Education
PSO Professional Service Organisation
PSS Personal Social Services
RHA Regional Health Authority
SSD Social Services Department
SSI Social Services Inspectorate
TOPSS Training Organisations in the Personal Social Services
vii
Preface
This book is about change in the management of public services – how
much of it and what consequences. For over two decades the goal of
restructuring welfare provision has been at the heart of UK government
policy. Under the Conservatives the focus was on controlling expendi-
ture and re-organising services to make professionals more accountable
for resource decisions. In health, education and social care, the objec-
tive was to install a system of managed provision heavily influenced by
the practices of private firms. After 1997, New Labour accelerated this
process under a different banner of modernisation. Today perhaps even
more so than a decade ago the dominant image projected by politi-
cians and the media is of a public sector in crisis. This is manifested in
a constant barrage of critical reports highlighting performance failure
and the limited availability and uneven quality of services. Root and
branch change, it is argued, is both highly desirable and unavoidable.
In this book our purpose is to chart these developments but also
raise questions about how they have been understood. In a good deal
of the literature it is taken as given that management in UK public ser-
vices has been transformed. New forms of organising are said to be
firmly established, while, across public services, more subtle shifts in
professional identities and commitments are under way. To be sure it
is often recognised that this process is contested and uneven. But for
most observers the longer term trajectory or direction of change is
assumed to be clear and beyond dispute. Indeed one gets the distinct
impression that the debate has moved on. Few practitioners or acade-
mics today appear willing to challenge the idea that public services are
now ‘managed services’. Fewer still question the assumption that man-
agement reform itself is a good thing or that progress has been made in
terms of improving the effectiveness of services.
In this book our aim is to develop a quite different account. We do
not deny that change has occurred or that, in some areas, professional
practice has been altered beyond recognition. But for us it is important
to question the idea that policy goals have been fully translated into
efficient new public sector services or even that they will be in the long
term. The attempt to reshape the management of welfare professionals,
we argue, has been far more contested and problematic than many
viii
Preface ix
assume. In our approach the public sector organisation is not taken to
be a passive instrument of policy. It cannot be assumed that whatever
new policies were deemed necessary were simply translated into new
patterns of action as was required by policy makers.
To develop these arguments this book presents a detailed review of the
published research on management change in three key sectors: health
care, housing and social services. In doing so our aim is to draw atten-
tion to the uneven nature of restructuring and to marked variations in
the way professional groups received and responded to the reforms. Our
intention is also to emphasise the wider costs and unintended conse-
quences of this process. Even after two decades of reforms, few would
argue that there are no problems left, or that there is little more to be
done.
Some readers no doubt will be aware that this book has been a long
time, perhaps too long, in the making. The original idea for it was first
floated by one of us (Stephen) in a paper presented at Cardiff Business
School back in 1994. The arguments put forward then, about the need
for a more comparative and sober evaluation of the new managerialism
struck a cord. It seemed to us that the literature was crying out for a
more critical appraisal of the reforms, one that took seriously the
ability of the professions to resist or mediate change. But, despite our
initial enthusiasm it was some time before we approached a publisher
(then Macmillan) and even longer before we embarked on the project.
Over this period much has changed, not least the transition to a New
Labour government. This required us to devote some time updating
our material and keeping abreast (if that is possible) with the torrent of
new policy initiatives and directives. However, we remain convinced
that the ideas formulated back in 1994 are as relevant today as they
were then. In our view there is still a pressing need to take stock of the
new managerialism and look critically at the process and consequences
of reform. It is our sincere hope that in what follows readers will agree
that we have at least come close to meeting that need.
In the course of writing this book we have received help and encour-
agement from a number of sources. First we should thank various people
at Palgrave Macmillan, including, Sarah Brown, Zelah Pengilley, Catlin
Cornish and Jacky Kippenberger for their support and, more impor-
tantly, patience over the past five years. We got there in the end. We
would also like to acknowledge the assistance of colleagues who over
the years supported this project and offered invaluable advice on how
to develop and improve it. Special thanks goes out go to Ray Bolam,
x Preface
Keith Soothill, Martin Kitchener, George Boyne, Robyn Thomas, Miguel
Martinez-Lucio, Sharon Bolton and Daniel Muzio. Finally Richard
Walker would like to acknowledge the support of the ESRC/EPSRC
Advanced Institute of Management Research under grant number
331-25-006 for this research.
Ian Kirkpatrick
Stephen Ackroyd
Richard Walker