Management in medicine

Along with all the other challenges facing managers and clinicians in the National Health Service (NHS) in the latter part of the 20th century is the conundrum of how to respond to the politicians' (of whatever party) exhortations to provide comprehensive health care, set against a backcloth in real terms of a deteriorating financial climate. The paradox becomes real when a district health authority (DHA) responds to the challenge and, on the basis of performance indicators, appears to perform well and finds that it is penalised for its success.