Managing people: the breakfast menu

Discusses an exploratory study of the impact of NHS reforms on the management of staff. Argues that "management" has moved from a view that staff should be provided with a secure and comfortable working environment to "labour" being viewed simply as a factor of production. The result seems to be an unprecedented sense of alienation among significant numbers of NHS staff. Proposes possible ways forward. The first focuses on the "means", accepting that the "ends" of the NHS will, for the foreseeable future, be dominated by the market. The second examines more closely the market-driven, business "end" or purpose and challenges the unitary view of the NHS Trust as a coherent business entity. Beyond these short- to medium-term responses, concludes that a return to a somewhat more flexible and less hard-edged human resources philosophy is a longer-term investment as the labour market tightens and skilled staff become scarcer in the later 1990s.