The local health system: An ethnography of interest-groups and decision-making

This paper identifies the local health system as an area for sociological observation and analysis. Within the local system professional, managerial and lay groupings are described, and their influence on resource allocation assessed. It is suggested that ultimate claims to membership of the Health Board rest on three different principles—patronage, worker syndicalism and the popular vote— and that this gives rise to three potential interest groups. The reconstruction of a controversy in the local system reveals the ways in which these different groups formulate and pursue their interests both within and out of the formal structure. Professional-lay and managerial-professional conflicts provide the central themes, and the paper is ultimately concerned with the question, who defines health needs?