The inception of the National Health Service: a daily managerial accomplishment.
OBJECTIVE
It is commonplace to talk of the UK's National Health Service (NHS) as having its inception in 1948 in an Act of Parliament which brought together many hundreds of widely dispersed organisations into one, new organisation, "the" NHS. This paper aims to challenge the concept of "a" National Health Service and to argue that the (seeming) accomplishment of this "organisation" is the daily task of health managers.


METHODS
The paper develops a theoretically-based analysis of how an "organisation" is accomplished through ongoing processes of construction. First, critiques of the ontological status of this thing called "organisation" are considered. Then Laclau and Mouffe's discourse theory of political action, inspired by Derrida and Gramsci is used, to try to understand this apparent "thing" and the work of those charged with its management.


RESULTS
There has been little application of this theoretical perspective to understanding management in general and health management in particular but, given the highly politicised nature of health management, their theoretical perspective seems more than apposite. Application of Laclau and Mouffe's theory to the NHS leads to the conclusion that there is no such "thing" as the NHS. There is, rather, a presumption of the thingness of the NHS and one of the major tasks of managers working "within" this organisation is to achieve this sense of thingness.


CONCLUSIONS
This is "work in progress"--these ideas continue to evolve, but feedback from readers is necessary.


CONCLUSIONS
This is the first time that Laclau and Mouffe's work has been used to analyse health organizations. The value of the paper is mostly for people working to develop critically-informed understandings of how organizations work.
Harding
Nancy
N
Nuffield Institute for Health, University of Leeds, Leeds, UK.
D013222:State Medicine / Q000458:organization & administration*; D006113:United Kingdom