title: Competition to co-operation in national health services: evidence of social and cultural effects as management issues.
abstract: OBJECTIVE
  This review examines how the management of health and health services is affected by the context of historical, social and scientific developments.
  
  
  BACKGROUND
  The paper was prepared for the author's inaugural lecture as Professor of Health Services Research at Canterbury Christ Church University College.
  
  
  METHODS
  The review had the benefit of being conducted during a 3-year NHS research and development study of decision-making in the nursing profession. A systematic literature review was conducted, yielding bibliographical data for analysis of health service issues.
  
  
  CONCLUSIONS
  There is a case for including management decisions on appropriate research measures in the health service. Another finding of this analysis is that the management of common needs-based budgets, for example through co-operative purchasing, is a way forward to reconfigure services and reallocate funds, in a context of anomalies and inequalities in health care.
authors.affiliation: Centre for Health Services Research, Canterbury Christ Church University College, UK.
authors.forename: W E
authors.initials: WE
authors.lastname: Lemmer
mesh_terms: D001294:Attitude to Health / Q000208:ethnology*; D003299:Cooperative Behavior; D003659:Decision Making, Organizational; D006302:Health Services Research; D006801:Humans; D008389:Marketing of Health Services / Q000458:organization & administration*; D015279:Organizational Culture; D009936:Organizational Innovation; D016134:Organizational Policy; D012922:Social Change; D013222:State Medicine / Q000458:organization & administration*; D006113:United Kingdom