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The many changes in the NHS resulting from recent legislation, including allowing hospitals to “opt out” and become NHS trusts, coupled with a new culture of managerialism, emphasising service quality, employee commitment and value for money has led to an increase in service monitoring and inspection. It has also led to an increasing emphasis on quality and indirectly has brought professionalism and managerialism into direct conflict with each other (The Griffiths Report, 193 and Working for Patients, 1989).

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