In the Eye of the Storm: Civil Servants and Managers in the UK Department of Health

In the wake of the 2008 financial crisis, the UK government faces some tough choices over public expenditure, and these choices will have important implications for both the future of health policy and the way in which health services are managed. In this article, we examine the organization and leadership of the UK Department of Health and weigh its suitability to meet such challenges. We find an organization that is culturally split between public servants and managers, highly reliant on the ability of its key personnel to bridge these divides, and extremely responsive to the political goals of government ministers. We explore the modern DH using three types of evidence. First, the history of the department shows clear political efforts to reduce civil service discretion and focus the DH on the management of the English NHS. Second, the recent organizational structures of the DH show a bifurcation between policy direction and NHS management tasks. Third, an analysis of the top ranks of the department since 2005 shows the implementation of political preferences that are consistent with managerialism but inconsistent with the perceived characteristics of traditional civil servants. The result is a department which has changed just as frequently as the health service it oversees – a department which has been moulded by successive ministers into one for the management of the NHS. Our findings raise important questions about the value and purpose of long‐term organizational knowledge in policy formulation.