Freedom to do what you are told: Senior management team autonomy in an NHS acute trust

Arguably, the government's aim of using the reward of 'earned autonomy' and Foundation Trust status as an incentive to improve performance in the NHS will only be effective if Trust managers view greater autonomy as both desirable and realistic. This article examines this issue by investigating the extent to which members of an NHS Trust's senior management team perceive themselves as autonomous, the factors most likely to hinder their ability to operate autonomously, and the extent to which managers want greater autonomy. In the event, autonomy was largely restricted by extensive centrally dictated targets. Entrenched professional interests and a lack of managerial skills on the part of clinician managers suggested limitations on the extent to which autonomy can be realistically devolved. Additionally, there was little belief among managers that greater autonomy would enable healthcare services to be delivered more effectively.