Managerialism and active citizenship in Britain's reformed health service: Power and community in an era of decentralisation

Milewa, Timothy and Valentine, Justin and Calnan, Michael .W. (1998) Managerialism and active citizenship in Britain's reformed health service: Power and community in an era of decentralisation. Social Science and Medicine, 47 (4). pp. 507-517. ISSN 0277-9536. (The full text of this publication is not currently available from this repository. You may be able to access a copy if URLs are provided)

The full text of this publication is not available from this repository. (Contact us about this Publication)
Official URL


The creation of a large managerial stratum within the British National Health Service in recent years has been one of the most striking characteristics of reforms intended to develop a more efficient and "business-like" service. An accompanying political rhetoric of decentralisation has cast local managerial autonomy as a means to gauge and respond more easily to the needs and preferences expressed by local communities. This article therefore reviews the growth of the new managerial stratum with particular regard to its emerging relationship with the local populations in whose name the organisational reforms have been wrought. The dominant political interpretation of this relationship that the organisational reforms constitute a movement from leaden "bureaucratic" administration to more locally accountable and responsive managerial regimes - is then tested with regard to an in-depth study of two health authorities responsible for very different local populations. Results show that the role of local populations in influencing decisions and determining priorities is considerably less than inferred by the sustained political rhetoric in favour of the "local voices". Consideration of possible trends in the state and economy suggests however that this disjuncture may not be explicable solely in terms of the new managerial stratum maximising its influence or of central government retaining a high degree of control.

Item Type: Article
Uncontrolled keywords: managerialism; managers; community participation; participation; local citizenship; local voices
Subjects: H Social Sciences
Divisions: Faculties > Social Sciences > School of Social Policy Sociology and Social Research
Depositing User: M.A. Ziai
Date Deposited: 05 Apr 2009 17:47
Last Modified: 06 May 2014 11:40
Resource URI: (The current URI for this page, for reference purposes)
  • Depositors only (login required):