Celebrate, don't denigrate: the case for management is clear
“Leadership and management in the NHS matter and the role of managers should be celebrated and not undermined.”
“Denigration of managers and the role they play in delivering high quality healthcare will be damaging to the NHS and to patient care in the short and long term.”
The Future of Leadership and Management in the NHS, the King’s Fund report from which these quotes are drawn, is a seminal intervention in one of the longest running health service debates. It should skewer once and for all the lie that NHS management has no positive contribution to make or that the service has too many people involved in management. Its conclusion is unambiguous: “There is no persuasive evidence that the NHS is overmanaged and a good deal that it may be undermanaged”.
The report’s power comes from the weight of evidence it is able to bring to support its argument. Over recent years the idiocy of trying to run an enormous and complex public service with levels of a management that the most frugal charity would look askance at has attracted increasing scrutiny. The work by the Centre for Innovation in Health Management arguing for more investment in management capacity, which HSJ publishes this week, is another powerful contribution.
The prime minister’s underwhelming speech on NHS reform earlier this week did at least pay tribute to the “important and valuable work” undertaken by managers. But he then immediately qualified his comments by saying: “But they’re not on the front line so sometimes they don’t know precisely what local patients need.”
Indeed, the shine was almost completely taken off the PM’s fainthearted support when, immediately after receiving the speech transcript, HSJ got an email from the Conservative Party claiming the reforms would make “the NHS work for patients, not bureaucrats”.
As the King’s Fund explains, such statements not only damage the morale of existing staff, but discourage clinicians, talent from outside the service and the best graduates from seeking a role in NHS management precisely when it faces its biggest challenge for a generation.
The most telling and urgent recommendation from the report is that the government should revisit its plans “to cut the number of management posts by 45 per cent”. It stresses that this target is “simply arbitrary” and “backed by no published analysis whatsoever”.
The playground politics that affects the debate over NHS management makes it very unlikely the government will climb down from this commitment, but it could simply lessen its oversight on this matter and let local organisations make the appropriate decisions. As the think tank’s report says: “While administration and management costs will have to take at least their fair share of the pain as real terms growth in NHS spending ceases, a more sophisticated approach to the reduction is needed.”
The government can also help itself by noting the report’s finding on how “extensive, overlapping and duplicating demands” by regulators have driven up administration costs.
But the report also places an obligation on those holding NHS management positions. We are doomed to repeat the sterile debates of the past unless all concerned take personal responsibility to challenge the urban myths surrounding NHS management.
HSJ suggests two tactics.
First, stop slagging each other off. Junior vs senior, commissioner vs provider – the generic denigration of any NHS “bureaucrat” simply gives more grist to the populist mill.
Second, the King’s Fund report – independent, evidence based, clear – can be a powerful tool in changing minds. So download it and the next time a colleague, local newspaper or politician or anyone else trots out the easy lie that “the trouble with the NHS is that there are too many managers”, you can simply say: “You’re wrong, read this.”
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Readers' comments (9)
Anonymous | 18-May-2011 11:03 am
Sadly, as we all know too well, this Government is not only evidence averse but takes a particular delight in simply making up facts to provide spurious justification for whatever piece of dogma they feel the urge to foist upon us. It shouldn't require a study like this to teach anyone competent in management science that denigrating managers (or making sweeping changes without evidence) is a bad idea. This Government's ministers aren't there because they have any managerial or leadership talent, however, but because Daddy made a fortune for them to inherit.
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Anonymous | 18-May-2011 4:43 pm
At last a credible report telling EVERY NHS manager what they already knew, but which the Government point blankly refuse to acknowledge. Anon 11.03 makes the point well about the underlying idealogy underpinning what is at the heart of this nasty, mean-spirited government. They are punch-drunk on the notion that their way is the only way and that we must get this 'deficit' down AT ANY COST even if that means destroying the very fabric of our society. Mr Cameron and his cronies should get their noses out of the Daily Mail and start reading some reasoned, intelligent and evidenced arguments which do far more to raise the debate than the nonsense they are being fed by their so-called advisers.
The Government still fail to answer the fundamental question for me which is how can an NHS manager with many years of specific managerial experience, the majority of whom earn far less than per year than a Championsip footballer does in a week be bad and yet a GP on £100k+++ pa with no specific commssioning experience plus a significant clinical workload to THEIR patients be good? I still remain unconvinced that even the best GP's will have the time to effectively manage both responsibilities. Something will have to give.
I wonder what it will be?
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Neil Jessop | 18-May-2011 6:31 pm
However, the national press will continue to say that the NHS is overmanaged as it helps to sell copy and I cannot see number 10 welcoming the Kings Fund report now or ever!!
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Patrick Newman | 18-May-2011 8:57 pm
Being under-managed and over administered does not necessarily mean there are not too many managers. Hospitals and many other healthcare NHS providers are large organisations and should be continually looking at their overheads and the management and administrative processes which can consume considerable resources.
My question in this topic is how much non clinical support and management resources are the result of the continuous structural and policy 'revolutions' reigned down by government and DoH?
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Anonymous | 19-May-2011 2:21 pm
There is a big irony in the current direction of travel. The dogma of the Conservatives is for further marketisation of health. This creates more transactions and inter-relationships that need to be managed. A health market can't be allowed to fail because people die. So the irony is that you would be stripping back management at exactly the same time as you need it to manage the new system as it becomes more complex and produces unintended consequences. It's time to listen to facts and not simple headline narratives! But remember the Milton Friedman economics of the Neocons is all about deliberately creating instability/panic/chaos to drive change!
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Lynne Heal | 19-May-2011 6:19 pm
New leadership in multiple sclerosis for CCSVI is needed interventional vascular radiologists are VITAL way forward for UK clinical trails as soon as possible to save the NHS billions of pounds someone needs to realise whats been going on for many many years
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Anonymous | 20-May-2011 9:20 am
Private sector providers spend more on management and leadership. The bill wants to open more of the NHS delivery to private sector providers. Management spending will rise. QED.
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tom Davies | 20-May-2011 12:00 pm
Ironic, then that our beloved secretary of State read (sorry, presented) a speech at the launch of the report, even to the point of describing management as a "profession".
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Blair Mcpherson | 23-May-2011 12:49 pm
The report states that NHS Trusts are in need of a new style of management leadership. A situation they describe as urgent in view of the harsh financial climate and big changes required in the NHS.
The culture change in management is to convince managers that poor performance is an issue for the line manager to address and can't be simple passed over to HR. However this is a deep routed problem which stems from the traditional way of appointing managers. All too often excellent professionals are appointed to management posts with no clear understanding of what being a manager is all about and no desire to get involved in the messy business of taking people to task over their performance, attendance or behaviour. In future when post are filled people need to be recruited for their people management skills as well as their budget management skills and relevant professional background. Existing managers need to be given support to acquire the necessary skills and confidence to lead their staff.
Most organisations start with re writing the job description and person specifications for management posts and go on to redesigning their management development programmes. It is a start but the real challenge is as this report states to develop managers leadership skills. If you are interested in reading a case study of introducing such an in house management leadership development programme you will find a detailed case study in Equipping managers for an uncertain future published by www.russellhouse.co.uk
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