Barriers to transformation: Beyond bureaucracy and the market conditions for collaboration in health and social care

The post‐1990 health reforms in health and social care have resulted in quasi‐markets, centralized funding and an acceptance of top‐down managerialism.The analysis of contracting within the public sector has focused on the extent to which the market has affected equity, access and choice for users ‐ but it has also had a tremendous impact on staff, staff morale and their relationships. Whilst policy makers demand joint practice in order to deliver continuous care, the market culture has resulted in competitive or depressed behaviour amongst professional managers and support staff. The bureaucratic public administrations were criticized for reinforcing rigid departmentalization and a stagnant culture ‐ the contracting environment and reductionist performance management (NPM and managerialism) appear to be having a similar blocking effect on those staff developing new relationships and working beyond establishment boundaries. This paper outlines what are perceived to be the barriers to social transformation in health and social care services, as relayed by those actively engaged in building bridges across professions and agencies. The research input is based on a mid‐stream ESRC Management Innovation Project.