Designing Health Service Organization in the UK, 1968 to 1998: from Blueprint to Bright Idea and ‘Manipulated Emergence’

Four sets of reforms of the National Health Service are employed to illustrate the changing character of policy making in this sector over a thirty year period, from the production of a carefully developed technocratic blueprint for its organization to the promulgation of a series of bright ideas accompanied by incentives for local actors to develop them into concrete organizational arrangements consonant with these ideas. We term this latter approach ‘manipulated emergence’ and relate it to the literatures of organizational culture and of post-Fordism. The approach adopted by the 1997 Labour government is largely, though not wholly consistent with this, and it remains to be seen whether the high-water mark of manipulated emergence has passed.