This book explores the daily realities of working life for mid-level managers in the UK’s NHS and critiques the movement towards a healthcare model, based around HMO-type providers such as Kaiser Permanente, that is well-known internationally but is often considered far from 'best practice' when it comes to patient care.

Preface: The ‘Highest Law’ 1. Deconstructing the Welfare State: Undoing ‘One of the Greatest Achievements in History’? 2. Deconstructing the NHS: The Changing Roles of Junior and Middle Managers 3. Exploring NHS Work: A Critical-action Perspective 4. Ready to do Business: Management and Organizational Change in an Acute Trust 5. Contested Culture: Managerial Work in an Ambulance Trust 6. Staying Afloat: Negotiating Change at a Mental Health Trust 7. When Organizations Disappear: Deconstructing Management at a Primary Care Trust 8. Managing the Impossible: The Challenges of Organizational Change in the NHS

This book represents an impassioned indictment of the misapplication of business principles to healthcare in the NHS. It offers a dystopian peek into the lived experience of dedicated health professionals struggling to maintain their professional integrity and a national institution in the face of a disturbing tension between business imperatives and ethics of care. Roy Suddaby, Winspear Chair of Management, Peter B. Gustavson School of Business, University of Victoria, Canada and Research Professor, Newcastle University Business School, UKThis fine book deconstructs the English welfare state (notably the NHS) in two ways: it critically explores what current health policy is doing to the NHS; and it tracks the NHS’s possible morphing into a new commercialised entity. It draws on extensive case study work to explore the experience of middle managers in such change, placing empirical work in a theoretical and political economic context. This important contribution informs a major area of policy, political and also public concern.Ewan Ferlie, Professor, Department of Management, King's College London, UKThis book offers a brilliant analysis of the work of healthcare managers in an age of major public sector reform. Lucid and thought-provoking, it provides much needed insight into the ethical and philosophical issues facing our public services today. Most of all, it offers a deep sociological appreciation of the movement towards ‘marketization’ and the threats this poses to publically-funded healthcare. Mary Jo Hatch, Professor Emerita, University of Virginia, USAShattering the myth that NHS middle managers are costly pen-pushers, this book emphasizes their critical contributions. With financial pressures and constant change, however, they are faced with ‘managing the impossible’. But is this deliberate policy? The authors suggest that the mix of complex governance systems, funding restrictions, and unrealistic targets ensure that the NHS is always seen to be failing, thus reinforcing the case for privatization - which is already happening. This is essential reading for anyone concerned about how the NHS is managed, locally and nationally. David A. Buchanan, Emeritus Professor of Organizational Behaviour, Cranfield School of Management, UK This book is a treasure in two important senses. Firstly it showcases first rate scholarly empirical research that seeks to explore what middle managers do in a number of important health care contexts. Junior and middle management roles are often overlooked by organizations and indeed by academics and policy makers. It is refreshing to see a spotlight being placed on these critical roles. Secondly it offers a thoughtful and impactful analysis of the changes seen in health care as part of the welfare state. The stealth revolution is highlighted where the scope of its availability is being questioned.Sue Dopson, Rhodes Trust Professor of Organizational Behaviour, Saïd Business School, UK