Suchergebnisse

The 'Rothschild reforms' of the early 1970s established a new framework for the management of government-funded science. The subsequent dismantling of the Rothschild system for biomedical research and the return of funds to the Medical Research Council (MRC) in 1981 were a notable departure from this framework and ran contrary to the direction of national science policy. The exceptionalism of these measures was justified at the time with reference to the 'particular circumstances' of biomedical research. Conventional explanations for the reversal in biomedical research include the alleged greater competence and higher authority of the MRC, together with its claimed practical difficulties. Although they contain some elements of truth, such explanations are not wholly convincing. Alternative explanations hinge on the behaviour of senior medical administrators, who closed ranks to ensure that de facto control was yielded to the MRC. This created an accountability deficit, which the two organizations jointly resolved by dismantling the system for commissioning biomedical research. The nature and working of medical elites were central to this outcome.

The Experimental Computer Programme (1967-1979) was the first central government intervention for hospital computing in the English National Health Service. Influenced by developments in the United States, the UK Department of Health envisioned integrated medical and management information systems, operating in real time. The approach to implementation was experimental and piecemeal. The program was overambitious for the computer technology available, but social, economic, and political barriers were equally significant. Despite positioning as a research program, evaluation was poorly managed. Although the program was judged to be a failure at the time, some projects were partially successful. The history of the program remains relevant to the question of how governments might best support hospital computing initiatives in relatively centralized, publicly funded health systems.

In the 1950s, the Ministry of Health, supported by interested groups outside government, recognised the political importance of productive efficiency. For leadership, organisational models and techniques the Ministry looked to the movement for industrial productivity. The NHS was receptive, but private-sector approaches were modified and dampened as they were imported. NHS management was to be the provider of technical expertise, but the deployment of this expertise was limited by clinical autonomy and de-coupling from financial incentives. This article casts new light on the history of productivity policy, NHS management and the moving frontier between state and civil society.