The development of a managed National Health Service (NHS) has been a central element of government policy for a substantial part of the last two decades. Within months of taking office in 1979, the first Thatcher administration repudiated the idea of a centrally planned and administered NHS in favour of a declared policy of managed localism (Klein1995: 124–26; Pollitt 1993: 68–9). However, a somewhat more considered process of policy formation was soon set in train with the commissioning of the Griffiths enquiry and, following the acceptance of its conclusions in 1983, with the introduction of what was called ‘general management’. Since the middle of the 1980s, the management which Griffiths recommended (which allocates considerable decision-making independence to managers within a framework of prescribed budgets) has been consolidated and developed.