Equity and Excellence: Liberating the Nhs.

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“Outline the main features of the current reforms to the NHS based on the 2010 White Paper “ Equity and Excellence: Liberating the NHS.” Review the reasons for the main proposals in this White Paper.”

The NHS trust underwent a major organisational change to improve flexibility and responsiveness to patients' needs. Although organisational change was beneficial to the patients, issues of power and control, ownership, gender and communication became predominant within the organisation. As a result, there were positive and negative implications for the employees and the managers, both in the NHS itself and the Site Service Directorate. The change merely deepened the divide between the two groups.

This essay will apply organisational theories to examine the impact of those changes from the perspective of the managers and teams.

The NHS introduced the generic worker concept, as it believed this was a cost effective and more rational approach (Crowther & Green 2004:14), and underwent a radical organisational change (Crowther & Green 2004:183), with changes to its structure and strategy. Due to an attempt to realise continual improvement in quality and value for money, the NHS tried to position itself as a post modern organisation in the patients' view by using Total Quality Management to increase performance and up to date service-level (Crowther & Green 2004:58) of its service for patients. However, from an employee and managerial perspective, the change involving a traditional step towards a Weber bureaucracy and any post modern influences on work practices also had their negative implications.

Theories from the functionalist perspective were used by the management to manage its employees. Functionalism meant that organisations have various roles or functions necessary to maintain order and stability (Lemieux 1998:34). This can be observed by the fact that the NHS having a Weber's bureaucratic approach, where there is delegation of tasks from managers to employees as mentioned in the case study "The domestics are divided into teams under a supervisor and are designated an area of the hospital" [section3; line 31-33]. Although organisations need to maintain consistent quality across all functions, Hollensen (2003) states that 'cross functional teams' form to provide all patients with the same level of services offered. This agrees with Mayo's human relations approach, who believed work satisfaction is achieved by being part of a team. Karl Marx's modernist perspective of downsizing and disposing of labour is evidence as "Some of the porters are assigned to specific departments, such as X-ray, but most are 'located' in a central pool and respond to demand for their service" [section 3; line 25-29].

Multiskilling is where workers possess a wide range of skills and knowledge appropriate for the use within an organisation. The main issue with the change to multiskilling within the NHS was that it was not based on what was beneficial for the employees or the union; it was based on the organisation making more money as the Finance Director, Steve Fountain, argued "the successful implementation would help to provide good value for money and make cost savings" [section 5; line 6-8] and they were also focusing on the competitiveness with commercial players, which provides a positive implication for the managers.

However it can be argued that it's a negative implication for the employees as managers' uses power and control in order for the implementation to be successful.

Power from the management, which is the ability of the senior managers to overcome employees and supervisors' resistance (Huczynski & Buchanan 2004:805) is prevalent at the NHS, as senior managers with their legitimate power due to the tall hierarchy (Schultz et al 2000:102). Mintzberg's machine structure approach to management, which is when decisions are made by the senior management, with the day-to-day activities being controlled directly by...
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