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Marketization, managers and moral strain: chairmen, directors and public service ethos in the national health service

Research output: Contribution to Journal/MagazineJournal articlepeer-review

<mark>Journal publication date</mark>1997
<mark>Journal</mark>Public Administration: An International Quarterly
Issue number2
Number of pages18
Pages (from-to)189-206
Publication StatusPublished
<mark>Original language</mark>English


Survival of the public service ethos in Britain has been called into question following introduction of the ‘new public management’ and marketizing reforms in much of the public sector. This article examines how these developments have occurred in the NHS, using survey data to analyse NHS board members’ substantive ethical values. Unexpectedly the results suggest that NHS board members with a predominantly NHS background appear less ethically conservative, more flexible and less risk–averse than those recruited from non–NHS backgrounds; and that as yet the NHS management ‘culture’ is not very homogenous in respect of ‘business ethics’. The NHS reforms also appear to accentuate the tensions between transparent public accountability in NHS management and incentives not to publicize certain types of information. Recent codification of NHS ‘business ethics’ can be understood as an attempt to buttress the public service ethos against the increased moral strains of a quasi–market.