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Is it harder to be an honest senior manager in today’s NHS?

Posted by:

21 January, 2013

In over 30 years working in the public sector, many as a senior manager, no one ever offered me money to look the other way, bought me an expensive lunch or even a bottle of whisky at Christmas.

I have no experience of corruption, but fiddling the performance figures, withholding information and ignoring inappropriate behaviour was all too common, usually because a manager wanted an easy life.

‘Is the gap between how we expect managers to behave and the reality getting wider?’

Staff often say they don’t trust senior managers, claiming they are not open and honest about plans to withdraw services and make staff redundant. Some senior managers believe telling the politicians what they want to hear is all part the game. These managers are enthusiastic supporters of the governing party’s policies and equally enthusiastic supporters of the opposition’s policies when it gets into power.

Is the gap between how we expect managers to behave and the reality getting wider? Is it becoming harder to be an honest and decent manager?

Political environment

Honesty, openness and integrity are expected of managers in the public sector. We like to think that in this country our public officers don’t take bribes and are not corrupt. In general that is probably true.

But league tables and naming and shaming have put a lot of pressure on managers to hit performance targets, which may be too much in some cases. Whistleblowers have revealed abuse and neglect in the NHS that managers failed to pick up on and challenge. Is this incompetent management or a focus on cost at the expense of care?

In a period of drastic budget cuts, all saving options are on the table − redundancies, closures, outsourcing −but mangers are not lying when they say no decisions have yet been made but they’re not able to be open and honest as the cabinet or board decides what is politically deliverable before the media campaigns kick in.

‘Cuts and their impact will create many situations where a senior manager’s commitment to honesty and integrity will be tested’

Managers in local government work in a political environment where decisions are not simply based on the business case but take account of party political priorities. The policies a council follows are those of the party in power. Senior managers are not required to agree with them, just deliver them, and that requires some convincing enthusiasm on their part. It would be unprofessional to do otherwise.

Old dilemmas

But what about when claims are made that staffing cuts won’t affect the quality of service when your experience tells you it’s inevitable? Is it ethical to keep quiet? Can you honestly say the proposed changes will bring about better services when you know the driving force is budget savings? Can you claim to value staff and the work they do while cutting pay and plotting to outsource services?

These are not new dilemmas for people working in the public sector but in the past health and social care services have had some protection from budget cuts due to the vulnerability of their patients and service users.

The size of planned cuts and their impact will create many more situations where a senior manager’s commitment to openness, honesty and integrity will be tested.

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