The 1983 Griffiths review of management was the direct outcome of the chaos of industrial action. Thirteen unions (including the BMA and the RCN) were involved.  While the main issue was pay, the unions also felt that the current system was no way to run a health service. 

Kenneth Clarke, as Minister to Norman Fowler’s Secretary of State, was concerned that the steady growth of non-medical manpower was adding an extra burden to the NHS.  Little progress was made over many meetings.  As well as the main negotiations, there were less formal contacts with the TUC and COHSEE, and with the RCN.  Ministers wished to get the nurses on side and having been told that there was a possibility of a pay review body specifically for them, the College’s opposition became more muted.  The other unions began to sense defeat and welcomed the ides of a management review as a component of the final offer.

The Permanent Secretary, asked to establish the review, used contacts in the Bank of England to find a good private sector manager who would consider the application of effective management principles to the NHS.  Roy Griffiths was a fine manager in a customer based service – Sainsbury’s.  Sir Kenneth had a difficult 45 minute interview with Griffiths who was poker faced until he smiled and accepted.  While Kenneth Clarke had wanted the review to be more about manpower than management, Griffiths insisted that manpower was the secondary issue.  A team of four was selected and the terms of reference were left somewhat vague, ‘to advise on the effective use and management of manpower and related resources in the NHS’.

The report, in the form of a letter to the Secretary of State on 25th October 1983, established the principles of general management in the NHS, replacing the system of consensus introduced by the 1975 reorganisation.  Griffiths had wanted doctors to be central to the new system, but this was seldom the case.  Nurses lost much of the power they had previously enjoyed.