‘Heroic’ NHS managers get their due from friend and foe
“Heroic” is not a word often used to describe NHS managers, so well done to NHS chief executive Sir David Nicholson for praising the individual efforts of primary care trust and strategic health authority leaders.
HSJ has three heroes of its own this week. The first is the most unlikely.
Who do you think he had in mind when he told HSJ “I’m a public servant and I’m not one of those people who denigrate the contribution public servants have made”
Dr Laurence Buckman, the British Medical Association’s GPs committee chair, has written to his colleagues suggesting they should look for commissioning support from NHS managers.
Good for him too. Not because there should be an assumption that commissioning support should come from ex-PCT staff - appointments should be made on merit - but because the BMA has spent too long undermining the efforts of NHS management and it is good to see it recognise the expertise and experience within many PCTs.
But let us probe the BMA’s motives a little deeper. We should take Dr Buckman’s advice to BMA members at face value, but also understand how it is influenced by fear as well as opportunity.
GPs’ greatest fear is that the general population will realise they are not part of the NHS workforce - weakening their status and influence at a stroke. It is one of the drivers behind the BMA’s disingenuous NHS anti-privatisation campaign. With national newspapers running lead stories about private sector businesses ready to sweep in and exploit the government’s public sector reforms, GPs are understandably anxious not to be seen as quislings. Their mindset also echoes the cornershop owner’s fear of the supermarket.
This dynamic between GPs and PCT managers will have a significant impact on the transition to the brave new world of GP commissioning.
Our second hero is Ealing PCT chief executive Robert Creighton. His impassioned illustration of the challenge facing PCT managers will resonate with many HSJ readers. His views on the average GP’s awareness of the risks and responsibilities of commissioning are also spot on.
Our last hero is Sir David himself. He wins that accolade for two reasons. The first is for committing himself to managing the transition despite knowing that most expected him to walk off in a huff when asked to tear up much of the system he had spent the last four years building.
Sir David’s approach of “when in doubt, centralise” does not endear him to all - and HSJ has had plenty of run-ins with the NHS chief executive as a result in recent years. But the greatest danger to the government’s reforms are a failure to deliver the efficiency savings required - which would destabilise the service and provide the greatest disincentive for GPs to take up the commissioning yoke. The “national management system” that Sir David will create over the summer will cause many to quail. It is unlikely to be pretty, but it probably has the best chance of keeping the show on the road over the next 18 months.
The other reason that Sir David is a hero - this week at least - is his refusal to join in the PCT bashing which has been so popular recently.
“He had no choice”, some might say, “he has been in charge”. True, but Sir David’s defence of his colleagues is heartfelt. When he says of working in the NHS “I can’t imagine myself doing anything else”, there speaks a man who is committed to public service and believes in the good managers can do.
As such, he has a poor opinion of those who stick the boot in - which may create some interesting tensions as the transition period rolls on.
Who do you think he had in mind when he told HSJ “I’m a public servant and I’m not one of those people who denigrate the contribution public servants have made both to the NHS and to society at large”?
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Readers' comments (14)
Anonymous | 22-Jul-2010 9:14 am
Well said. Everyone working in the NHS wants it to succeed, and to be the best.
It is right to remember that the BMA is simply a trade union seeking the best for its members, so it is absolutely right to weigh Dr Buckman's views accordingly.
I note that Mr Lansley, intent on giving away the responsibility for commissioning the NHS to GP members of the BMA trade union, was not on the list of this week's heroes.....
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Anonymous | 22-Jul-2010 1:18 pm
No doubt medals will handed out with P45s.
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Anonymous | 22-Jul-2010 1:25 pm
Lansley is the only hero. I haven’t seen a Secretary of State for Health that has been so radical and bold since Milburn. No one expected Nicholson nor the London NHS CEO to resign, because there are no £260,000 jobs out there with huge pensions for ex-NHS CEOs. Creighton was interesting but he appeared to be in a state of shock, and wasn’t clear about the way forward (i.e. the need to deliver QUIPP regardless of any changing landscape). Buckman and the BMA prefer weak commissioners because GPs have been running rings around PCTs for years, and they wouldn’t want this to stop under any new regime.
As for denigrating public servants, unfortunately poorly performing ‘leaders’/managers just get away with it, and cause the whole system to fail by their poor resource allocation decisions. They get vast salaries and huge pensions, well in excess of the Prime minister, and only deliver ‘poor to mediocre’ performance. If these people were removed early, the NHS wouldn’t have needed another shake out. The real heros of the week are the competent doctors, nurses, and managers who act in the public interest by putting their patients interests before their own self interests.
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Anonymous | 22-Jul-2010 4:43 pm
anon 1.25
Oh hell. Another 'manager slagging-off' post, with its usual exhausted catalgoue of unhelpfully broad and unsubstantiated swipes. Maybe its carhartic for you - I hope so.
At the moment I'm surrounded in this PCT office by people who are working for patients. Just got out of my third meeting of the day with clinical staff where we were working for patients. I didn't see anybody there who was working for their own self-interest (other than the fact we're all real people with real mouths to feed and real bills to pay - does that count ?).
And actually, I do think lanseley's bold. I dpon't agree with everything he's saying, but let's go with it. But if we're talking being stifled by bureaucarcay and paper, has anyone anything to say about the hundreds of pages of paperwork which we're all suddenly being hit with by DoH. Slim it down please, ladies and gents.
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Anonymous | 22-Jul-2010 7:34 pm
I think describing SHA and PCT leaders as heroic is completely absurd. Our soldiers in Afghanistan are ‘heroic’ for their bravery, courage, and self sacrifice. No CEO or board of any SHA or PCT has ever demonstrated any of these leadership traits in the NHS or elsewhere. The NHS CEO should withdraw this term because it is insulting to the brave men and women who have served this country with distinction and who actually deserve the accolade.
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Anonymous | 23-Jul-2010 1:42 pm
A well written and heartening editorial. I have to say that calling NHS managers of any ability or hue "heroic" is stretching the boundaries of credibility a tad, however if it focuses our attention on a lot of their good work instead of allowing space to ill-informed, sweeping assertions from neo-fascists like Anon 1.25 above, then I'm all for it.
Oh - and please stop this "more than the prime minister" nonsense. Its not very big, clever or indeed, factually correct!
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Anonymous | 23-Jul-2010 2:21 pm
An excellent editorial, thank you. In my experience there are both good and bad managers and doctors. Might it not be about which profession is in charge, but the commissioning task asked of them? Most other countries don't commission, they just have payers. We need to think as much about the task we ask of them as the person in charge, to understand why they perform as they do.
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Anonymous | 24-Jul-2010 11:43 am
If anon 1:42 pm is a CEO or board director of an NHS organisation the NHS has serious problems. Some people need to be stroked and have their egos massaged rather than accept the facts. Assuming anon 1:42 pm is a CEO or board director it looks like some CEOs and board directors can’t handle the truth, and unfortunately they call themselves NHS leaders/NHS top talent. Anon 1:42 pm is not worthy of any position in the NHS never mind a CEO or board director position.
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Anonymous | 24-Jul-2010 9:36 pm
If anon 1:42 pm is a CEO or board director of an NHS organisation the NHS has serious problems. Some people need to be stroked and have their egos massaged rather than accept the facts. Assuming anon 1:42 pm is a CEO or board director it looks like some CEOs and board directors can’t handle the truth, and unfortunately they call themselves NHS leaders/NHS top talent. Anon 1:42 pm is not worthy of any position in the NHS never mind a CEO or board director position.
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Anonymous | 26-Jul-2010 6:23 pm
I agree with the comments in the article.
Most people that work in the NHS do not get paid large sums of money nor do they get bonuses or paid overtime, most work in the NHS to help patients. Managers are brought into the NHS to manage clinicians attitudes and personalities which often differ from those of patients, relatives and carers!
I think Mr Lansley thinks we earn the same as him??? That just says it all MP's making decisions about departments when they have never worked in them. I suppose Mr Lansley can at least ask his wife and father in law, both GP's by the way. At least he is looking after his family by getting the GP's a payrise!
I cannot wait for the carnage to happen and I will look on as the Tories mess everything up only 5 years to wait for a new government! I am counting the days!!
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Anonymous | 27-Jul-2010 9:52 am
How interesting, 10 comments all of them anonymous! Why are people connected with the NHS so reluctant to reveal their identity? Is the entire system stacked against respect for thought or opinion?
Although unconnected with the NHS, what I have seen of it leads me to believe that the edifice of integrity has crumbled to the point that the Appointments Commission and other connected Quangos needed to be abolished along with PCTs and SHAs. Mr Lansley should also take a serious look at the professional standards of Monitor if Foundation Trusts are to be a big part of the future.
Sadly anonymity would seem to remain preferable for all until it is safer to come out.
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Anonymous | 27-Jul-2010 4:16 pm
The Corner Shop analogy is an excellent one in describing GP practices - What Buckman et al fear most is that, in time, GPs will become salaried staff of a private commissioning/provider company (Virgin, United Health, Kaiser Permanente etc) - There is such a lot of money in "health" and it can't be entrusted to the amateur!
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Anonymous | 27-Jul-2010 5:54 pm
Heroic they are not and its an abuse of the term but nice words for staff losing their careers at the same time as being blamed for everything that has gone wrong.
Well I hope they get everything they are entitled to out of the system. Lansley will be remembered as the Sec of State who destroyed the National Health Service. Lets hope the electoral time table unravels before real damage is done, patients and staff are starting to see how bad it can really get under a Conservative Government.
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Anonymous | 27-Jul-2010 6:01 pm
9.53am - yes no-one is allowed to openly question policy direction , it started with the Labour lot, moved quickly through the tiers and muzzled the vast majority.
Its now left to the UNIONS to speak up, that includes the likes of MiP/UNISON/RCN who are currently seeing the biggest recruitment boom for 30years.
These Conservatives are not in a safe position and they know it, hence the manic rush to dismantle anything and everything as they are not likely to last a full term..
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