The New Managerialism and Public Service Professions

Transcription

1 The New Managerialism and Public Service Professions

2 The New Managerialism and Public Service Professions Change in Health, Social Services and Housing Ian Kirkpatrick, Stephen Ackroyd and Richard Walker

3 Ian Kirkpatrick, Stephen Ackroyd and Richard Walker 2005 Softcover reprint of the hardcover 1st edition All rights reserved. No reproduction, copy or transmission of this publication may be made without written permission. No paragraph of this publication may be reproduced, copied or transmitted save with written permission or in accordance with the provisions of the Copyright, Designs and Patents Act 1988, or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1T 4LP. Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages. The authors have asserted their rights to be identified as the authors of this work in accordance with the Copyright, Designs and Patents Act First published 2005 by PALGRAVE MACMILLAN Houndmills, Basingstoke, Hampshire RG21 6XS and 175 Fifth Avenue, New York, N.Y Companies and representatives throughout the world PALGRAVE MACMILLAN is the global academic imprint of the Palgrave Macmillan division of St. Martin s Press, LLC and of Palgrave Macmillan Ltd. Macmillan is a registered trademark in the United States, United Kingdom and other countries. Palgrave is a registered trademark in the European Union and other countries. ISBN ISBN (ebook) DOI / This book is printed on paper suitable for recycling and made from fully managed and sustained forest sources. A catalogue record for this book is available from the British Library. 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 (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.K dc

4 Contents List of Tables List of Abbreviations Preface vi vii viii 1. Introduction 1 2. Professions and Professional Organisation in UK Public Services Dismantling the Organisational Settlement: Towards a New Public Management The National Health Service The Personal Social Services Social Housing Conclusion: Taking Stock of the New Public Management 154 Notes 181 References 183 Index 207 v

5 List of Tables 1.1 Total UK Managed Expenditure on Health, PSS and Housing Expenditure on Health, PSS and Housing as a Proportion of UK Gross Domestic Product Total UK Managed Expenditure on Health, PSS and Housing in Real Terms UK Public Sector Employment in Health, Social Services and Housing Local Authority and Housing Association Stock Holdings in England Comparative Analysis of Policy in Three Sectors Comparative Analysis of Professional Organisation 172 vi

6 List of Abbreviations AHA ALMO BMA CCETSW CHA CHI CIH CIPD CCT DGA DHA DoE FE GDP GNP GP HIP HT LSVT MBA NFHA NHS NICE NPM OECD Ofsted PSO PSS RHA SSD SSI TOPSS Area Health Authority Arms Length Management Organisation British Medical Association Central Council for Education and Training of Social Work Community Health Authority Commission for Health Improvement Chartered Institute of Housing Chartered Institute of Personnel Development Compulsory Competitive Tendering District General Hospital District Health Authority Department of Environment Further Education Gross Domestic Product Gross National Product General Practice/Practitioner Housing Investment Plan Health Trust Large Scale Voluntary Transfer Master of Business Administration National Federation of Housing Associations National Health Service National Institute for Clinical Excellence New Public management Organisation for Economic Co-operation and Development The Office for Standards in Education Professional Service Organisation Personal Social Services Regional Health Authority Social Services Department Social Services Inspectorate Training Organisations in the Personal Social Services vii

7 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 expenditure and re-organising services to make professionals more accountable for resource decisions. In health, education and social care, the objective 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 politicians 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 services 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 academics today appear willing to challenge the idea that public services are now managed services. Fewer still question the assumption that management 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

8 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 attention 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 consequences 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 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 encouragement 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 importantly, 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,

9 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 for this research. Ian Kirkpatrick Stephen Ackroyd Richard Walker