The Good of the UK National Health Service, As Such

The question of how to coordinate the UK National Health Service (NHS) has been answered by drawing on a variety of discourses which constitute it as a system, institution, or, more recently, a brand. The formal organization that follows these conceptions is rarely considered with respect to organizational conduct because academics and politicians often assume, implicitly or explicitly, that organizational forms will adequately reflect and advance a particular set of values commonly held at any given time. These assumptions often demonstrate themselves to be problematic when one or another set of values becomes threatened by supposedly targeted reforms. For example, the introduction of a new legislation can be perceived to disrupt and fragment professionalised bureaucracies, or a national IT program can put into question the meaningful existence of a single ‘NHS organization’. In analysing contemporary political reforms to the NHS, we build upon Chester Barnard’s contrast between lateral and scalar formal organization, in order to shift the discussion about coordination of the NHS from a fixation on the successive ills identified in its history and present, to an elaboration of the forms of conduct appropriate to each kind of organization, and the dysfunctions inherent within each, which one should expect, and seek to govern by appropriate means. Barnard’s thinking allows us to show how the surfacing of inherent tendencies toward self-destruction in different systems of organization have not only been used to justify successive ‘knee-jerk’ reforms at the expense of “the good of the organization as such”, but also that the good can be better realised by adopting a pragmatic stance that treats the NHS as an object of ongoing coordination and cooperation.