Chief Executives and the Modernization of the English National Health Service

Abstract

The popular image of an empowered, proactive leader fails to reflect the reality of senior managers’ roles in public sector organizations in the UK at the present time. This point is developed through a study of senior chief executives in the English National Health Service (NHS) between 2000 and 2002 when, in response to perceptions that the Service was in crisis, the New Labour government introduced a ten-year modernization programme backed by substantial increases in public funding. In previous years considerable interest had been shown in the importance of leadership within public sector organizations. However, by the time of this study senior politicians in the UK had become suspicious about the abilities of public sector managers in general, and those within the NHS in particular, to deliver the reforms that they had deemed essential. A series of interviews with NHS chief executives over the 2000-2 period recorded the pressures that they were subjected to: rather than being given the scope to help lead the reform of the NHS, chief executives were treated as little more than conduits for the policies of the centre. The interviews illustrate how undermined and demoralized many of them came to feel. Relating the episode to the broader literature on leaderships it is suggested that the study of leadership in the public sector cannot be divorced from broader study of the institutions of the state and, in this case, from the centralized performance audit regime that government developed to drive forward its modernization policy. In the light of such issues, the article draws attention to the importance of ‘bureaucratic discretion’ to the theory of public sector leadership.