Review

Middling management

CONTINUITY AND CRISIS IN THE NHS
Ray Loveridge and Ken Starkey (eds)
Open University Press, 1992

Discussion of change and evolution in health services in the UK has been dominated over the past 5 years by grand plans and massive structural engineering. This collection of essays, by contrast, edited by academics in the fields of management and organisational analysis, examines innovation on a more practical and local level.

The strength of this focus - on middle management, district policies, hospital design, information systems - is to root the book in the real world of day-to-day compromise and failure. Unfortunately, the coherence and relevance of the collection as a whole is also compromised.

For example, an account of the introduction of a new computerised information system in an accident and emergency department makes an entertaining and salutary tale, yet the eventual message of the chapter is not clear. A piece on pharmacy management in Tayside is so specific as to be of limited interest to all but pharmacy managers.

Where the book succeeds is in discussing broader issues in the NHS of the 1990s, such as the future of primary care or the problem of burgeoning managerialism. In summary, then, good in parts.