So, did the NHS change as a result of the HIV epidemic? So many managerial changes were going on in the 1980s within the UK, that HIV was just one other factor forcing the process. Major changes were seen where HIV impacted most, e.g. genito-medical clinics came out of the closet and offered attractive career opportunities for doctors, nurses and health advisors alike. The infection control departments of hospitals also came into their own. Where Chief Executives decided HIV was not only a public health issue, funds were made available for district-wide responses. So, health service managers often only became involved once large sums of money were made available from the centre.
More broadly, there are lessons to be learned for the management of the NHS from the impact of the crisis, and the authors explore how organizational learning does not always come from an individual stimulus but, where it does, the stimulus can effect 'un-learning' as well as learning and 'highlight the importance of informal as distinct from formal learning'. The authors conclude that, because of the patchiness of the direct effect of HIV as a health issue on the NHS as a whole and the 'normalization' of HIV over the past 10 years, 'the NHS seems still to forget more than it learns'.
The authors have looked at an historical event and analysed how it affected the organizational structure of the British NHS. They highlight the importance of both informal and formal networks within both statutory and non-statutory organizations as being a mobilizing force in change. They admit they now need to 'carry this organizational analysis forward to what (they) would see as the latter stages of the issue in the 1990s but are 'heartened by the confirmatory evidence revealed in this study, which suggests that changes in health care may take generic rather than totally idiosyncratic forms'.
Having led the planning and implementation of a district-level AIDS programme in the mid to late 1980s I found myself nodding in agreement with many of the findings in this book. I am sure many of my colleagues from that time would do the same. What is important is the relevance of these findings to the management of the NHS today. HIV and AIDS have broken down barriers between managers, doctors, and nurses and between specialities. They have had a profound effect on the doctorlpatient relationship. They have pushed forward the boundaries of care of the dying and challenged negative attitudes to lifestyles which were often based on a complete lack of knowledge. It would be a tragedy if these gains were lost. This book and books like these are essential reading for all health care workers in order to keep alive the issues HIV and AIDS raise, and to keep open the doors of learning within the NHS.