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Purpose

Sets out to examine arguments that attribute a lack of an ethical dimension to the management function.

Design/methodology/approach

Discusses the role of health service managers in the context of the NHS and the political and economic contexts in which they operate.

Practical implications

The challenge faced by senior managers in the NHS, i.e. trying to provide high‐quality, accessible services and to remain within budgets, is recognised as formidable and ethically complex.

Originality/value

Efficiency and choice can be compatible objectives but their achievement within the NHS is likely to be more difficult than political rhetoric might suggest.

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