Healthcare has recently turned into perhaps the most critical aspect of public policy in the UK due to two major issues: the finance and provision of health care. On the finance side, there is currently recognition that health care in the UK has been underfunded in comparison with most other Western European countries for at least the last two decades (Dixon & Mossialos, 2002). On the health care provision side, the National Health Service (NHS) admits lack of workforce and, what is even more important, insufficient quality of service and targets to effectively rectify these problems though the improvement initiatives are perceived by many as barely achievable in the timescale set by the government (Timmins, 2001).Although majority of the challenges facing the UK healthcare system are perceived as the result of economic factors, poor funding is not the sole factor to be held responsible. Vast economic, social, technological, and economic changes occurring in world nowadays seem to contribute to the difficulties experienced by the health care industry too. The key feature underlying these modifications is increased attention to human resources.Managerial effectiveness is one of the core factors that determine effectiveness of modern organisation, including the National Health Service. The National Health Service (NHS) is the common name of the publicly funded health care systems of England, Scotland, Wales, and Northern Ireland. These four health systems operate in the United Kingdom, and though they developed within different legislative framework, operate collectively on the UK territory. Currently, the NHS has approximately 1.3 million employees including almost one million full-time personnel (BBC, 2006). Although these impressive figures make the NHS one of the largest employers in the world, it has not been until recently that the managerial aspects of its operation drew serious public and expert attention.
The existing research in the field of health care management allows to identify several major challenges facing the average NHS manager.
1. External Pressure
NHS managers have recently become one of the most favoured objects for public and media criticism (Preston & Loan-Clarke, 2000; Case Study). Furthermore, the government also contributes to the external pressure. The reforms initiated by the government over the last years require the managerial staff of HNS to dramatically and immediately change control, efficiency and accountability of their work in order to justify and reduce the amounts of funds spent for the NHS annually. However, the time-frame set by the government to achieve this goal is clearly too short granted the organisation's size and previous operation (Buchanen & Preston, 1992).
Evidently, the requirement to achieve the new levels of performance effectiveness formulated by the government can hardly be met under such circumstances. Consequently, frustration, anxiety, and perceived inability to properly do their work became the characteristic feature of NHS managers these days. Thus, the general perception of the managerial profession by NHS managers is highly pessimistic: "the middle manager occupies the most uncomfortable position in the NHS. The managers feel that their role is unrecognised by patients,... the public and the government" (Case Study).
2. Internal Pressure
Increasingly high internal pressure is another problem facing NHS managers these days. Perhaps the most essential factor contributing to this sort of pressure is "... the need to manage professional staff with equal or higher status... [and] ... a high degree of autonomy" (Case study). In light of the current requirements to improve the quality of performance by exerting stricter control and introducing the special Code regulating