Care delivery in the current NHS context

SECTION A: Since Francis report (2013) exposed systemic NHS culture issues that led toorganisational failings, there has been an increased interest in researching NHS organisational
culture. However, a shared understanding of NHS culture challenges is needed in order to address them. Therefore, this literature review systematically reviewed 11 qualitative studiesexploring current organisational NHS culture challenges. The narrative review findings describe the negative impact of target-led priorities and managerialism in the NHS, neglected staff wellbeing, and these issues' effects on service user care. The review calls for a broadening understanding of the NHS culture across different professions and recommendsexploring NHS organisational culture from a socio-political perspective using a discursive approach.

SECTION B: A turn towards a neoliberal mode of NHS governance in the 1980s gave rise to business-efficiency-led organisational NHS culture that can conflict with compassionate care priorities. However, research on how clinicians manage these competing NHS rhetorics remains scarce. Therefore, this study utilised Foucauldian Discourse Analysis to explore NHS clinicians' language regarding care delivery. Following an analysis of seven organisational meetings from a single Mental Health Directorate in the South East of England, four discourses were identified. In turn, they describe a dominant care-as-business rhetoric, a discourse of managerialism that ensured adherence to the NHS-as-business governance, a state of crisis in the current care delivery standards and a competing discourse based on compassion that aimed to rebalance power relations in the NHS. The research findings highlight how taken-for-granted business rhetoric shape clinical action and demonstrate the need to consider the broader socio-political context when evaluating care delivery standards and facilitating organisational culture transformation