PERFORMANCE, EVALUATION AND THE NHS: A CASE STUDY IN CONCEPTUAL PERPLEXITY AND ORGANIZATIONAL COMPLEXITY

This paper adopts a comparative perspective towards the analysis of performance evaluation in the National Health Service. The NHS, it is argued, is best seen as an organization which is not unique but which ranks high on a number of dimensions: uncertainty about the relationship between inputs and outputs; heterogeneity of activities and aims; the ambiguity of the available information. These factors help to explain why performance evaluation in the NHS is both conceptually and organizationally problematic, and fragmented and professionalized in practice. By looking at the same factors in other organizations, it may be possible to start constructing a framework for examining the problems of performance evaluation in different settings.     

Attention to Detail: The Conservative Policy Agenda

Since 2001 (if not since 1997) the Conservative party has struggled to develop a coherent set of policies with which to provide a credible alternative to the Blair government. A second successive crushing election defeat fuelled the ongoing debates in the Conservative party, between those who were convinced of the need to steer towards the centre ground, thereby reviving the Conservative's 'one nation' tradition, and those who wanted to place clear blue water between themselves and New Labour, and thus adhere to Thatcherite radicalism. The Conservatives have therefore appeared to struggle in developing clear, alternative policies on such issues as 'tax-and-spend' and public service reform and delivery. They have, however, inched hesitatingly towards a more socially liberal stance on various issues. A major problem for the Conservatives has been that the Blair governments have actually continued with, or consolidated, many policies inherited from the Conservatives in 1997, thereby making it even more difficult for the Conservatives to articulate their own distinct policy agenda. This is likely to contribute towards a third heavy defeat for the Conservative party in the next general election.