From 1989 to the present, various policies for the NHS have been followed by both the Conservative and New Labour governments. These policies have included, the provision of increased money and the improvement of the management efficiency. In the first of these policies the increase of money has been adhered to, however this increase in expenditure has not been sufficient to cope with the ever increasing population. In 1991,there was a period of immense change and new challenges within the health service. NHS reforms have effected the way in the NHS operates, reforms are leading to a gradual improvements in the quality of care, responsiveness to individuals and even better value for money, from the growing NHS budget. The introduction of competitive tendering for contracts has stimulated a new focus on the quality of care patients are receiving. As the standard of management is often reflected within the quality of service this shall be the viewpoint of this work.
             After years of the Thatcher governments attempt to cut back public spending her successor John Major sought to instil a more positive approach to public services with the introduction of a Citizens Charter, this was later followed by the Patients Charter. Within the NHS patterns have not followed any specific trend, however the NHS had the idea of re-organisation to increase efficiency, by changing the structure as soon as anything goes wrong, this often missed the real problems. The current structure seems to be more specific and compact, starting with the removal of the health authorities. This in itself reduced costs and allowed the NHS to become much more efficient and strive to producing a quality service. Maxwell,(1991,p181-182) argued this point in respect of quality of service this a feature of general management and that all employees are responsible for quality.
             The initiation of the concept of quality management can be traced to two American management sci...