Between the devil and the deep blue sea: managing the NHS in the wake of the 1990 Act

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Abstract
The article traces the ideological origins of the 1990 NHS and Com munity Care Act, and the growing political emphasis on managrement and the introduction of an internal market. It argues that while both managerial power and responsibilities have increased, the fragmen tation of agencies at the periphery together with a policy vacuum at the centre have created constraints as well as challenges for managers. While some positive outcomes are discernible, issues of equity, purpose and accountability continue to pose complex problems for managers and for the populations they serve.1