Reorganising, 1970s: The 1974 National Health Service Reorganisation and McKinsey & Company
This chapter demonstrates how the reorganisation of major state bodies such as British Rail, the Bank of England, and the Atomic Energy Authority heralded the emergence of the “American generation” of consulting firms. Set against a backdrop of fears of British economic decline, the perceived superiority of American management “know-how” is demonstrated as a purported solution to Britain’s ailments. American consultancies, actively—and with considerable success—sought to build relationships with state officials through infiltrating and mimicking “elite” networks. This chapter presents the first of two detailed case studies: McKinsey & Company’s support for the 1974 NHS reorganisation. Particular focus is placed on the cross-party continuity behind the reforms, which challenges long-held assumptions regarding the adversarial nature of British politics. In addition, the peculiar geographic boundaries of the NHS—highlighted by the work of the consultants—and how they are demonstrably not coterminous with the British Isles are highlighted.