Managers have been unfairly served by the rushed reforms

13 July, 2010 | By Alastair McLellan

“In the crucial area of public service reform, we have found that Liberal Democrat and Conservative ideas are stronger combined… You have a united vision for the NHS that is truly radical: GPs with authority over commissioning… elections for your local NHS health board.”

So wrote David Cameron and Nick Clegg in the foreword to the coalition’s “programme for government” published on 20 May. Less than two months later the Liberal Democrat component - their flagship health proposal - has been scrapped.

What are the chances, as things stand, of enough management talent still being available?

Good thing too. HSJ advised against elections to boards during the campaign. But far more telling than the lack of influence the coalition’s junior partners have over health policy is the rapidity with which the government’s plans are forming and changing.

“Pace” is the key word, according to civil servants at the Department of the Health working on fleshing out the government’s programme. After seven years as shadow, health secretary Andrew Lansley is a man in a hurry.

He knows momentum is important in achieving public sector change, look at how Labour’s plans began to founder in the last few years.

But the price of pace is time spent working out the detail. The government’s plans still beg a multitude of questions and the timetable set out in Liberating the NHS means there is little scope for addressing them fully.

The new commander of US forces in Afghanistan General David Petraeus described his task as: “Building an advanced aircraft while it is in flight, while it is being designed and while it is being shot at.”

That is effectively the challenge the government has chosen for itself in reforming the NHS so rapidly.

The flak of course is being provided by the need to find £20bn of efficiencies while attempting widespread system change.

In one of its most euphemistic passages, the white paper declares: “SHAs and PCTs… should seek to devolve leadership of QIPP to emerging GP consortia… as rapidly as possible, wherever they are willing and able to take this on [our italics].”

The accompanying “analytical strategy paper” declares: “SHAs and PCTs will cease to exist, but there will be a reliance on them in the short term around both managing the transition period and delivering ongoing efficiency savings.”

The very last paragraph of the white paper makes a plea to retain the managerial talent it will need to meet this challenge: “There will be opportunities for managers to help build a more innovative and responsive NHS”.

However, the roles they suggest - “managing finance and contracts” - are a relatively small part of the task ahead and, wilfully perhaps, misunderstands the breadth of the management contribution.

This is a problem because, as the white paper covertly recognises, primary care trusts are still likely to have a role well into 2013, the intended date for achieving the efficiency targets. By then, the areas still left to convert to the new system will be the most problematic - and will therefore require the most skilled management input.

But what are the chances, as things stand, of enough management talent still being available? For most, the lure of the relatively secure provider sector or the more lucrative consultancy business will have proven too strong.

The day after the white paper was published, Julia Manning, chief executive of right-leaning think tank 2020health, wrote: “The reality is that no GP consortium will be able to deliver improved care without good management… There are many good people for whom today is a lot more uncertain than yesterday and without whom we would not have seen many of the improvements that have been achieved. The NHS will never be perfect, but it cannot thrive without good management, and they did not receive justice yesterday.

We could not have put it better ourselves.

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Readers' comments (22)

Anonymous | 13-Jul-2010 3:59 pm
It is correct that the NHS and GP consortia cannot do without Good Management. Unfortunately Good Management is so rare in the NHS that we almost forget that these people do exist. Good Managers know who they are and others know who they are. They shouldn’t have any problem finding another suitable position in or outside the NHS. However, for all other managers who have hung on the coat tails of the Good Managers, there is no hiding. The NHS owes nobody a living.
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Anonymous | 13-Jul-2010 5:52 pm
I hold no brief for the Lib Dems but find your dismissal of their influence unconvincing. The original proposal was tor councils to appoint local councillors and elect patient representatives to Boards whose executive directors would be appointed through the Department. Compare that mishmash with the transfer of important and potentiallly growing local authority responsibilities for health and I think we can be clear that local democratic influence is likely to be more real under the latter than the former. And presumably this change is the positive objective of both coalition parties.
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Anonymous | 13-Jul-2010 6:11 pm
If it's true that the good managers will move on quickly, it would be better to close down the PCTs sooner than 2013 rather than leave them to a lingering death doing more harm than good. PCT Non Execs. and chairs should be removed as soon as statutorily possible since it is difficult to see what continuing role they now have. Small executive transition teams might be given the task of managing the change locally, perhaps with public accountability demonstrated through reports to overview and scrutiny committees and public proceedings of SHA meetings. That way, timewasting rubber stamping can be minimised, salaries and expenses quickly eliminated and large parts (all?) of the Appointments Commission also closed down from an early date.
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Anonymous | 13-Jul-2010 7:58 pm
In the thirty years working in the NHS I have never felt so anxious about the future of the health service. I love my job, I always have loved working for the NHS. I am known as one of the hardest working commissioners in the PCT and I feel very 'hard done to'. I find it heart breaking to stand and watch all I have worked for be abandoned as all my team request redundancy or are to finished as they are on fixed term contracts.

Some colleagues are eagerly hoping to collect handsome redundancies whilst lining up other employment opportunities. I myself await the HR framework to assess the risks /opportunities of staying or leaving. The pace of change is too fast and too risky. I predict a massive drain of talent from PCTs unless the pace of change starts to managed more competently. I feel as I am on the bridge of a very good ship sinking fast. This cannot be good for patients. Change is very much required in the NHS but it needs to be managed intelligently.
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Anonymous | 13-Jul-2010 8:26 pm
I am an outside observer but from my own enquiries I am left in no doubt that there are issues at the highest levels in some PCTs, SHAs and Monitor that require drastic surgery. That is not to say that there may well be huge numbers of dedicated and talented individuals who have been betrayed by the poor standards of those to whom they are responsible. The need for change and better accountability is patent but the baby should not be thrown away with the bathwater.
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Anonymous | 13-Jul-2010 8:30 pm
If it's true that the good managers will move on quickly, it would be better to close down the PCTs sooner than 2013 rather than leave them to a lingering death doing more harm than good. PCT Non Execs. and chairs should be removed as soon as statutorily possible since it is difficult to see what continuing role they now have. Small executive transition teams might be given the task of managing the change locally, perhaps with public accountability demonstrated through reports to overview and scrutiny committees and public proceedings of SHA meetings. That way, timewasting rubber stamping can be minimised, salaries and expenses quickly eliminated and large parts (all?) of the Appointments Commission also closed down from an early date.
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Anonymous | 14-Jul-2010 10:12 am
It will be interesting to see where the predicted "drain of talent" from PCTs drains to. Every part of the public sector is facing cuts and the private sector is spoilt for choice when it comes to recruitment. NHS managers are not renowned for their innovation and agility, qualities that are prerequisites in the private sector. This time there won't be the recycling we saw in the last restructure, simply because there's nowhere left to go now.
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Sue Owen | 14-Jul-2010 11:45 am
I am deeply distressed by all that I am reading and hearing about these changes that I being thought up on the hoof by a man in a hurry to dismember a body whilst it lives and breathes. I have worked in the NHS in various parts since 1986 and have been part of a lot of change and improvement; this new stuff is only change - it will NOT be improvement. It is hasty and ill-conceived back of a fag packet stuff that will destroy the NHS - then they can say it doesn't work so we must privatise it. We need senior NHS people to get off the fence, stop protecting their privileged positions and stand up for the service that made them what they are...come on Helen B, David N et al - you can't really believe giving self-serving GPs the budget is going to IMPROVE the service.
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Anonymous | 14-Jul-2010 2:27 pm
Well said HSJ. Since the so called NHS Chief Executive will not stand up for managers it is good to see you taking a lead.
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Anonymous | 14-Jul-2010 2:28 pm
When are we going to hear from the supine Institute of Healthcare Management?
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Anonymous | 14-Jul-2010 2:29 pm
Nicholson is looking after his buddies but not his profession
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Dr Paul Worthington | 14-Jul-2010 2:51 pm
Anon 2.28.
It's increasingly a lightweight voice. One of the reasons I'm not a Member anymore. Sorry IHM
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Anonymous | 14-Jul-2010 3:03 pm
I'm disgusted by David N and Anderw Lansley quite frankly. The NHS has come a long way in the past 5-10years, although I admit that there's still a way to go. So why waste all the hard work and investment (yes millions of pounds Lansley!) and do a complete U-turn?

I am a manager and have invested over 10 years in the industry, working in private and public health, along with Consulting. I came back to the public sector to be closer to the patients and make a difference and now I find my effort is being rewarded with job uncertainty. There is some real management talent in the NHS, which will be lost, as others have mentioned. The public sector's biggest asset is it's staff....and the new Government is squandering it. Long term the best will lose faith and leave to the consulting practices, GPs won't be aware of how to commmission and will commission external consultants to advice, thus costing more money. The HSJ themselves highlighted recently that an audit of GP consortium spending highlighted that over 75% of GPs either overspent or underspent by greater than 10%....so why give them an even bigger budget...MADNESS!

David N is clearly looking protecting himself and Lansley is clearly after a quick political win. if you want to reduce the public deficit that much, why not invest in long term solutions that will improve efficiencies. Slashing staff is not a sustainable solution and if he knew anything about improvement programmes he'd know that.

I'd suggest perhaps we look to sack idiots like Lansley, Cameron and Nicholson and save some money there.
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Anonymous | 14-Jul-2010 6:54 pm
I totally agree with Sue Owen and admire her courage. How many others are prepared to speak out?
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Joe Bloggs | 14-Jul-2010 10:05 pm
A lot of assumptions here. This isn't a policy 'on the hoof'. Lansley made his policy clear for years. Another assumption is that there have been great improvements in last 5-10 years. There has been the most monumental waste of money in that period and not enough to show for it. The Editor thinks the changes are unfair on managers. For some that is true. For the majority, including the most senior, they did not deliver and are now facing the truth and consequence. The axe must also fall on DH. They must not be allowed to continue untouched. They are ultimately responsible for wasted resources, blame and bullying cultures, an obsession with many pointless targets, and developing cliques of in and out people.
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observer | 14-Jul-2010 11:57 pm
Did anyone notice that the White Paper mentions Pensions? Lord Hutton is to examine whether they represent a barrier to labour mobility between the Public and Private sectors, and hence a barrier to plurality of provision (and therefore Choice).

Hmm. So if they are a barrier we have a choice of allowing the private sector to offer NHS pensions (which will cost the state more) or reducing NHS pensions to the non-existent levels of the lowest paying private sector organisations (which will cost the state a lot less). Wonder which option he'll pick?
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Anonymous | 15-Jul-2010 10:43 am
It is easy to blame the "managers", they have no voice, no politcal lobby, Union, Professional Body or "old-boys club" to defend them. The vast majority of managers I have worked with care passionately about patient care, despite being told constantly that clinicians have the copyright on this.

Yes we must get rid of the waste which is used to prop up poor politicians and feed the DH machine, but if the politicains really believe that a business the size of the NHS, with a workforce of over million, can be run with no management infrastructure, they are deluded. I suspect there will be plenty of work for employment lawyers in the future!

If we really want to understand where the money goes, why not take a look at the consultant & GP contracts. I am sure if the general public understood the details, MP expenses would look small-fry!

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Anonymous | 15-Jul-2010 11:04 am
I can't help but feel that the "spin" put on the work of PCT's and SHA's is a huge own goal for the government.

Calling people "red tape" and "bureaucracy" is insulting - scrapping PCT's and SHA's and wording it as such implies they have no value.
Yes, the NHS is not where it needs to be.
Yes change needs to happen - but what change management methodology are they applying in assuming insulting the commissioning teams - that are still expected to deliver the £20 billion savings over the next 4 years (3 of which will be before GP consortia take over) is seen as the best way to motivate them?

Bureaucracy and red tape exists – it’s in the system, but I am yet to find a commissioner who revels in it - it is a hurdle to everyone. The system needs fixing, but implying managers are personally responsible for this and tarring everyone with the same brush is not the way to inspire a team to perform.
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Anonymous | 15-Jul-2010 12:33 pm
It would be interesting to identify the added costs that the new GP and Consultant contract cost the NHS. It seems GPs pocketted a huge salary increase- not for more work - but for less. Do we imagine they will take on the vast extra duties without very large payments, and do we imagine they wont need to employ managers who have some experience of commissioning. Chances are we will pay managers very large redundancy packages, cause untold stress and misery , increase unemployment , loose income tax revenues and then start employing the very same managers to do the work for GPs who have neither the knowledge or skills that have been developing in PCTs. Clearly this Government has no qualms about providers being purchasers.
I for one feel that PCTs had become too expensive but this government seems determined to throw the baby out with the bathwater. No worries about the NHS in the future - this is the begining of a very rapid end for the NHS. Doors are open wide for privatisation. GPs are not NHS Employees but independent contractors It might have been better to go out to tender so that organisations with existing knowledge and skills could have sought to commission services. The lack of any kind of consultation on these proposals is disrespectful and at odds with the governments expressed wish for shared decision making. " No decision about me without me" is good for patients - NHS staff deserve the same consideration.
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Anonymous | 15-Jul-2010 9:26 pm
I have spent the last week being part of the red tape. Doing financial returns that do nothing to help the running of my PCT but are something the Dh insist on. Will they stop asking for all this nonsense? no.....

It is easy to blame the managers for wasting money but arguably the system doesn't give you a choice. You get given money and you have to spend it within 365 days or else! Control totals are the way of managing risk. There is no concept of long-term planning. You either spend it by 31 March or lose it and face the consequences. it is not that easy to just spend money wisely when you are on short notice -allocations tend to come at the death. Anyone seen Brewster's Millions?? That is NHS Financial planning in a nutshell..... Don't criticise us in comparison to the private sector when you don't let us operate like a "normal" business.
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