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By Rob Flynn

Utilizing numerous facts the writer records the increase of common administration, the appliance of recent options to lessen scientific expenses and increase potency, and different easy methods to keep an eye on use and overview scientific functionality.

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Extra resources for Structures of Control in Health Management (International Library of Sociology)

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These are not decisions normally taken by those at the ‘end of the line’. (Steele 1985:78) Recent measures in the hospital sector (and to a much lesser extent in the family practitioner service too) have thus been aimed at amending this ‘inversion’ of ordinary line management: central and local managers are seeking to define the limits of doctors’ clinical freedom, previously entirely a matter for professional jurisdiction. It seems reasonable to conclude at this stage that there has been a longterm, systematic, though uneven and variegated imposition of ‘scientific management’ within the NHS.

The former basically refers to the state’s recognition of an occupation’s professional competence and jurisdiction (the terms of its work), whereas the latter refers to specification 38 Structures of control in health management of tasks, and evaluation and regulation of quality (work content). What remains in dispute is whether current developments in industrial capitalism and the welfare state represent a fundamental expansion in heteronomy, so that both the terms and the content of professional work are more strictly circumscribed by external bodies.

Of course it is quite possible to qualify these rejections of the thesis by noting that they are based on experience in organisational settings and financial circumstances which are very different from those prevailing today. The most pragmatic course is not to exclude the notion of bureaucraticprofessional conflict in its entirety, but to recognise that professional autonomy coexists with, and may be contingently limited by, administrative and organisational constraints. At different times there will be variations in the degree of employee discretion and managerial control.

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