This introduction presents an overview of key concepts discussed in the subsequent chapters of this book. The book offers a critical examination of working life in a changing National Health Service (NHS) as seen through the eyes of junior and middle managers. It describes the current condition of the NHS, drawing attention to the profound challenges it is facing in terms of growing patient demand, shrinking resources, and the rise of external competition. These challenges are then explained in more detail with reference to a resurgent neo-liberal attack on the idea of free public healthcare and the autonomy of clinical professions. Finally, the book concludes with an explanation of why the authors have chosen to draw a distinction between management and managerialism. The post-war welfare state was part of a larger trend in which a technocratic government would act as monopolistic provider of health and welfare services as entitlements to citizens.