Dominant, challenging and repressed interests in the NHS

Examining New York's health care system, Alford noted that the most powerful interests were those of the professionals, whose values were widely accepted by society. Managers, with different and sometimes conflicting interests were less powerful but had much influence. The interests of groups in the community, however, had little voice or influence and were harmed by the others. Charlotte Williamson applies this theory to explain important features of the British scene. Values are not confined to the interest group which they reflect, so that on the one hand CHCs can support measures which are in the interest of staff rather than patients, and on the other hand advocates of community interests will sometimes support the values of professions or of managers.