Reluctant public sector entrepreneurialism among clinical professional managers: Corporate colonisation in the English National Health Service

Abstract

In public service, the replacement of traditional professional and managerial cultures by a more entrepreneurial ethos has reemerged as a political goal in recent years, presented as a necessary response to acute fiscal challenges. In this paper, we consider the impact of increasing influence of enterprise and entrepreneurial discourses in the UK public sector, specifically in respect of healthcare in the UK. We examine the evolution of managerial and professional identities in healthcare in the UK, considering the evolution of health service management identities from administrator through leader to entrepreneur in the late twentieth and early twenty-first centuries. Drawing on an empirical study of a health care organization in the English National Health Service, we examine how engineered competition in this sector drives opportunistic entrepreneurial behaviour among staff, with direct implications for the identity and conduct of professional healthcare managers. Following Deetz on ‘corporate colonization’, we explore the perceived inevitability of this shift, even where it is felt that such changes occur to the detriment of professional and clinical concerns. We integrate these practical and theoretical issues together to critically evaluate how short-term entrepreneurial activity acts as a powerful organizing principle, at the risk of undermining the ethics of care