Social science and health policy in the United Kingdom: some contribution of the social sciences to the bureaucratization of the National Health Service.

Abstract

A current and major health policy, the first fundamental reorganization of the administrative structure of the National Health Service (NHS), is reviewed in this paper. The shake-up in the administration of the NHS is seen as having two main components: a partial integration of the three separate administrative branches, and an injection of a particular kind of managerial ideology. This “management revolution” is seen as consisting essentially of a powerful thrust toward central and bureaucratic control of the NHS. Social sciences in the broad sense–ranging from work study (organization and methods study) through social medicine and sociology to economics-are reviewed in relation to their contributions to this bureaucratization of the NHS. It is shown that narrow and out-of-date organizational studies and technocratically oriented social medicine have contributed significantly, if sometimes unwillingly and unwittingly, to the drive toward centralization and bureaucratization. Rejecting a highly bureaucratic form of organization for a national health service, the authors discuss briefly some developments which reflect a more decentralized and more adaptive pattern of administration. The paper suggests that independent research foundations with a strong interest in health have a responsibility to break the incestuous relationships which have developed with the health department in some instances. It is suggested that foundations, professional associations, unions, and consumer groups could promote the maturation of “medical sociology” and “administrator's social science” into a full-blooded sociology of health. Currently social science within the health field in the United Kingdom is seen as being both underfinanced and prostituted to the interests of medical and administrative power groups. A participatory framework for social science is outlined as an alternative to the current models which are based on Taylorism or “scientific management.”