The Reluctant Managers: Clinicians and Budgets in the NHS

A review of the literature on management budgeting, combined with recent fieldwork in a number of health authorities, points to major weaknesses in both the theory and practices of management budgeting. The lack of major incentives to clinician participation and of significant penalties for non-participation are seen as central to the failure of management budgeting to achieve either rapid or widespread adoption. In addition, it has been insufficiently appreciated that many managers themselves are less than enthusiastic about the prospects for workload-related budgeting. Finally, it is suggested that, though novel in some important aspects, resource management may often suffer similar difficulties.