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Benjamin Richards: 3204685 Page 1 Benjamin Richards: 3204685 M25BSS: Research Methods Course: MBA General Management Organisational and clinical change in the English NHS (70) Organisational change has been a persistent feature in the English National Health Service (NHS) since its initial formation, accelerating with the Thatcher Government and continuing until the present day and shows no signs of abating. This research will consider what impact organisational change has had on clinical care in the NHS, whether the changes that have occurred are enhancements as a result of less bureaucracy, or a detrimental effect due to the impact of constant distraction on those tasked with managing the wide range of services. BACKGROUND The NHS is "entering a period of unprecedented financial challenges that will result in major changes to the provision of health services" (Palmer, 2011) thus both the introduction of a new government and the financial pressures facing the UK economy as a whole are leading to the next phase of NHS reforms, part of which will be again a large organisational change within the NHS in England. Since its creation on 1948 the use of the word National in relation to the health service has always been a misnomer for the United Kingdom. The legislation did in fact create three national health services, for England and Wales, Scotland and Northern Ireland. As the process of devolution has progressed, this has increased to four national health services as England and Wales have split to become separate national services. This paper will focus on the NHS in England. Primarily this is due to the fact research by the Nuffield Trust shows that it is by far the largest service and consumes the largest amount of UK Gross National Product and employs the biggest staff base. Due to its coverage it also treats by far the largest number of patients of any of the four national health services.
Benjamin Richards: 3204685 Page 2 England Wales Scotland N Ireland Population (million) 50 3 5 1.7 NHS Budget (£ bn) 75 4.7 6.7 2.5 Staff Numbers GPs 32500 2400 3250 1105 Nurses 300000 30000 55000 13600 Hospital Medical 87500 5400 12500 3740 Total 420000 37800 70750 18445 Figure 1 : Comparison of the UK Health Services in 2006 (adapted from Connelly et al, 2010) Service change in a system as large as the English NHS presents itself in a variety of ways, be it fundamental system pathway redesign and new ways of working to working to improve health outcomes and patient care; or organisational change, possibly as a result of the implementation of new methods of working, but also as a political tool as a way to reduce actual or perceived over-management or bureaucracy. As an employee of the English National Health Service (from this point forward I will refer to it solely as the NHS, all references to the NHS should be taken as referring to the English NHS unless otherwise stated) for a period of seven years, I have personally been involved in two large scale NHS reorganisations with a third just commencing. The presence of change is so fundamental within the

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