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 indepth 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.
Mots-clés Pascal : Système santé, Royaume Uni, Europe, Participation, Décentralisation, Réforme, Participation communautaire
Mots-clés Pascal anglais : Health system, United Kingdom, Europe, Participation, Decentralization, Community participation
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0397219
Code Inist : 002B30A01B. Création : 25/01/1999.