MANAGERIALISM AND ACTIVE CITIZENSHIP IN BRITAIN REFORMED HEALTH-SERVICE - POWER AND COMMUNITY IN AN ERA OF DECENTRALIZATION

The creation of a large managerial stratum within the British National Health Service in recent years has been one of the most striking char acteristics of reforms intended to develop a more efficient and ''busi ness-like'' service. An accompanying political rhetoric of decentralis ation has cast local managerial autonomy as a means to gauge and respo nd more easily to the needs and preferences expressed by local communi ties. This article therefore reviews the growth of the new managerial stratum with particular regard to its emerging relationship with the l ocal populations in whose name the organisational reforms have been wr ought. The dominant political interpretation of this relationship that the organisational reforms constitute a movement from leaden ''bureau cratic'' administration to more locally accountable and responsive man agerial regimes - is then tested with regard to an in-depth study of t wo health authorities responsible for very different local populations . Results show that the role of local populations in influencing decis ions and determining priorities is considerably less than inferred by the sustained political rhetoric in favour of the ''local voices''. Co nsideration of possible trends in the state and economy suggests howev er that this disjuncture may not be explicable solely in terms of the new managerial stratum maximising its influence or of central governme nt retaining a high degree of control. (C) 1998 Elsevier Science Ltd. All rights reserved.