Reshaping common sense: management, power and the allure of medical leadership in England’s NHS

Summer 2018
DOI: 10.3898/SOUN:69.05.2018

Leadership in the NHS is deemed necessary because medical science (in its broadest sense, including the knowledge and expertise of a range of expert disciplines) has developed beyond the organisational and management capacities of a health service designed when Penicillin was not yet in widespread use. Attempts to overcome this contradiction by deploying a market-oriented system of general management (New Public Management) have largely failed. This article will outline the historic development of both the medical work that the NHS does, and the ways in which that work is managed. It will then describe the leadership function as it is currently promoted in the NHS, before going on to discuss and evaluate leadership from the perspective of Gramsci’s ideas about the formation of a collective intellectual, and the transition by intellectuals from traditional to organic roles; and it will do so alongside a consideration of the characteristics of the ‘cadre’, as described by Göran Therborn.

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