Pettigrew (Pettigrew A., 1988) argues that research in change within the NHS should be looked at from a processual, comparative, pluralist and historical perspective. He further argues that the NHS has been, since the mid 80s, under a number of pressures which he attributes to the following:
- growth in the public demand for services
- the pace of technological change
- cash limits to welfare provision
- growth of consumerism
- government’s changing priorities.
He highlights the fact that there is a gap between statements of strategic intentions and operational reality – the difference between rhetoric and reality.