This study examines the history of general hospital nursing in Sheffield between approximately 1948 and 1974 – the first 26 years of the operation of the National Health Service (NHS) in England. The availability of nurses in quantity and in quality, their knowledge and skills, working practices and organisation, are themes that endured during this quarter-century. This was a period when administrative and therapeutic innovation was juxtaposed with – and constrained by – resource limitations. In particular, the inability to match nursing availability to patient needs caused operational and strategic problems in developing and delivering hospital-based health care. These problems were exacerbated when innovations in nursing and medical care required new approaches to the organisation of hospital beds and equipment, which also had to be implemented in nineteenth century buildings with inadequate basic facilities. Making extensive use of archived records of Sheffield’s hospitals, the present study explores how the coalescence of these factors influenced nurses and their work, and how this contributed to continuity and change in nursing in the city’s general hospitals.

General hospital nursing in Sheffield during the early years of the NHS, 1948-1974.

Development of a normative framework for the management of an integrated public service system and public value generation with regard to municipalities in the Western Cape province

Contact factors are responsible for the thrombogenicity of prothrombin complex

The first major reorganisation of the National Health Service took place in 1974, twenty-six years after the service had been established. It has long been perceived as a failure. This article draws on archival records and a witness seminar held in November 2016 to provide a more nuanced assessment of the 1974 reorganisation and understand more fully why it took the form that it did. In particular it identifies the reorganisation as an important moment in the ongoing story of management consultants engaging with health policymakers, and explores the role of McKinsey and Co. in detail for the first time. Key explanatory factors for their involvement are identified, including the perceived lack of expertise and manpower inside the civil service and the NHS, and perceptions of their impact and effectiveness are discussed. Many debates about the use of management consultants today were directly foreshadowed during the early 1970s. Alongside this, the role of other groups of policy actors, including civil servants, politicians and medical professionals, are established and the extent to which British health policymakers have had to work within existing cultural, political, legislative and practical constraints when trying to initiate change is demonstrated. The fact that many of the ‘mistakes’ that were made have been repeated in the course of subsequent reforms, speaks to the poor institutional memory of Whitehall, and the Department of Health and Social Care in particular. In the run up to 1974 management consultants could make only a limited contribution to an imperfect compromise.

/pdf/mckinsey-and-the-tripartite-monster-the-role-of-management-1nxm0m7neu.pdf

McKinsey and the ‘Tripartite Monster’: The Role of Management Consultants in the 1974 NHS Reorganisation

To meet the need and resolve long standing conflicts in the delivery of primary care in an age of specialization, I propose an experiment with a different type of primary medical education...

A career in ambulatory medicine.

are involved: the consolidation of the tripartite structure into a single unified system, the strengthening of management processes, and the expansion of machinery for making health services more responsive to local needs. While generally supportive of the reorganization, this assessment of the changes in policy and structure identifies a number of constraints in the form of political realities and organizational-administrative capabilities which may limit the attainment of objectives. In particular, the bias in modern medicine for hospital-based specialization, the uneven power relationships among competing professional interests, and the continued separation of health from social services are seen as restricting policy aimed at altering the balance between primary, secondary, and tertiary levels of care and between curative and "carative" services. Since the pressures underlying the reorganization of the National Health Service (NHS) reflect the broad changes accompanying social and economic development, such as the aging of the population, the shift from acute to chronic patterns of illness, and the decline in the marginal social benefit of capital-intensive medical technology, England's experience may be relevant to other highly developed countries, both as a field laboratory for the elucidation of alternatives and as a case study of the complexities inherent in any attempt to carry out large-scale organizational change. With the possible exception of Sweden's, the reorganization represents the most ambitious attempt to institute comprehensive health services planning and integrated delivery among Western capitalist countries.

https://www.jstor.org/stable/info/3349631

Reorganization of the National Health Service: background and issues in England's quest for a comprehensive-integrated planning and delivery system.

Britain's National Health Service is to undergo a massive restructuring on April 1, 1974, the chief aims of which are to introduce greater managerial efficiency and to promote a better balance among hospital-focused specialists' services for acute treatment, community-based family-practitioner services for primary care, and the care of the long-term chronically ill. The machinery for these changes involves, first of all, the unification of hitherto separate hospital, family practitioner and public-health services into an integrated system, secondly, the participation of clinicians in management and, thirdly, the introduction of multidisciplinary consensus teams for management and planning at operational levels. Notwithstanding a number of shortcomings, the reorganization appears both necessary and timely. The main criticism is that insufficient action has been taken to link up health with social services, so that another major reorganization is inevitable in the foreseeable future. (N Engl J Med ...

The 1974 reorganization of the British National Health Service--aims and issues.

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Reorganization of the National Health Service: background and issues in England's quest for a comprehensive-integrated planning and delivery system.

The 1974 reorganization of the British National Health Service--aims and issues.