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The Yale church historian, Sydney Ahlstrom, had just emerged somewhat dazed from the Sixties when he reviewed the religious trajectory of the United States during that decade. He wrote that by 1966 it was clear that ‘the post-war religious revival had completely frittered out, that the nation was moving towards a crise de la conscience of unprecedented depth’. As well as a ‘growing attachment to naturalism and “secularism”’ he mentioned ‘a creeping or galloping awareness of vast contradictions in American life between profession and performance, the ideal and the actual’ and ‘increasing doubt concerning the capacity of present-day ecclesiastical, political, social and educational institutions to rectify these contradictions’. As Ahlstrom made clear in a later essay, he saw the crisis faced both by the Roman Catholic Church and by the ‘mainline’ Protestant Churches as part of a wider loss of ‘confidence or hope’ in American society and a passing away of ‘the certitudes that had always shaped the nation's well-being and sense of destiny’.
There has been much recent debate on the impact of competition on the English National Health Service (NHS). However, studies have tended to view competition in isolation and are controversial. This study examines the impact of programme theories associated with the health system reforms, which sought to move from a dominant target-led ‘central control’ programme theory, to one based on ‘market forces’, on orthopaedics across six case-study local health economies. It draws on a realistic evaluation approach to open up the policy ‘black box’ across different contexts using a mixed methods approach: analysis of 152 interviews with key informants and analysis of waiting times and admissions. We find that the urban health economies were more successful in reaching the access targets than the rural health economies, although the gap in performance closed over time. Most interviewees were aware of the policies to increase choice and competition, but their role appeared comparatively weak. Local commissioners’ ability to influence demand appeared limited with providers’ incentives dominating service delivery. Looking forward, it is clear that the role of competition in the NHS has to be considered alongside, rather than in isolation from, other policy mechanisms.
Historians of the future may come to rank the 1960s alongside the 1520s and the 1790s among the great revolutionary decades of Europe's religious history. Indeed, the religious significance of the 1960s is even wider, since equally radical changes were taking place in North America and Australasia. And the atmosphere of the 1960s also had much in common with that of those other revolutionary decades. History moved faster during these years, and a dynamic of change built up which old institutions and traditions were powerless to withstand. For some people, a new era of apparently limitless possibilities was opening up. As in many other periods, the rebels and nonconformists had an influence out of proportion to their numbers. However, this was also a period of profound yet unspectacular social changes. In focussing on flamboyant manifestations of the counter-culture or the most trenchant forms of political radicalism, there is a danger of overlooking more mundane developments which were changing the lives even of the conventional majority.
The importance of the 1960s in the religious evolution of the western world is widely recognised and there is a growing body of historical and sociological literature describing and explaining the changes in that period. There is also considerable agreement as to the main directions of change at that time, in spite of significant differences of emphasis. But there is no consensus at all as to the causes of change.