Neo-Bureaucracy and Public Management: The Case of Medicine in the National Health Service

Abstract

Contemporary public service management in the UK is accompanied by discourses of the ‘third way’ and ‘new public management’ that claim to stand in contrast to older bureaucratic approaches based on hierarchy and rule-adherence. Our examination of approaches to the management of National Health Service medicine over the last twenty years suggests the reverse: that in this particular sector at least, there has been increasing bureaucratisation, though based on rules enforced by regulatory agencies rather than by hierarchical management. Drawing on a number of long-established literatures, we argue that this ‘neobureaucracy’ is likely to possess inadequate technical, political and behavioural capacities for what is expected of it.