The lost opportunity to review management

While the listening panel goes about its business and Number 10 takes a closer interest in the NHS, the area where some new reflection is really required is neither policy nor structure but management. NHS management needs to be defined much more operationally rather than politically. A golden opportunity has been missed to be managerially radical.

There are expectations, and possibly some optimism, associated with the current ‘listening exercise’, especially following last week’s elections, but whatever emerges the NHS will continue to change. Show me an industry that doesn’t and I’ll show you an inevitable failure. 

But while the listening panel goes about its business and Number 10 takes a closer interest in the NHS, the area where some new reflection is really required is neither policy nor structure but management.

We’ve seen the NHS Leadership Council come and go (not the first initiative of its type by any means), GP commissioning development start, and the NHS top leaders’ programme emerging. But I can’t help wondering if there has been any national corporate reflection on future NHS management requirements.

The NHS is excellent at segueing from one regime to the next with real pride in management’s ability to deliver the changes. But this always happens without any consideration of management requirements to deliver the future. And the trouble with management is because of NHS over-emphasis on leadership, management’s reputation has been denuded.

To be fair this is also something of an international phenomenon. Inevitably the NHS plays catch up - management always lags behind policy and developments in management, for example technological advances, the rise of consumerism, freedom of information and corporate social responsibility. In turn this produces inefficiencies, and arguments about service and organisational change. Wouldn’t it be good if management requirements anticipated the future rather than react to the present?

Times of national change to the NHS inevitably expose the weaknesses of the separate professional pillars on which the NHS is built and the lack of cross-disciplinary integration, especially in management. Consequently, I have no doubt we’ll once again see the representation-based arguments for membership of new NHS organisations emerging as they’ve done in the past. 

But the inevitable centrally driven desire for organisational conformity goes against the grain that there is rarely ever one right organisation. There’s only an organisation that fits the task and that depends on many factors, most of them local rather than national. Furthermore, looking at trends in the private sector, downsizings and restructurings clearly indicate that data-oriented and routine management jobs are continuing to be replaced by technology.

This too is inevitable for public services and some organisations eventually will see the complete demise of middle management. If NHS management is to be successful in the future then it needs to be defined much more operationally rather than politically. A golden opportunity has been missed to be managerially radical and agree, among other things, a new set of inter-professional, managerially integrated relationships and freedoms. The risk now is that once the dust has settled we will hail a new set of structures but do things in the same old way.