I am obviously biased, so you tell me - should consultants be viewed as an asset?

Should they be given the time to maintain skills, contribute to the advancement of medical knowledge, apply new thinking, raise standards of care, and ultimately deliver on that quality agenda that now seemingly defines our next NHS phase?

The alternative? Care delivered by someone who only has time for clinics and on-call, with six hours a week for (necessary) mandatory training on hand-washing, fire regulations, carrying and lifting and equality and diversity, not to mention education, training, supervision, mentoring, research, service management, etc.

The NHS managed clinical business perspective is seemingly paying lip service to what is without a doubt the most challenging aspect of managing the knowledge worker - performance managing that knowledge worker.

The clinician is the expert knowledge worker who leads the clinical pathway, helping to define what is in the best interests of the patient, informed by that patient. Clinicians cannot sustain and develop their knowledge and skills in six hours a week. The ten hours originally agreed in the consultant 2003/04 contract had a basis which is now being eroded by managers who see the short-term cost saving but fail to see the long-term consequences of this short-term managerialist attitude.

It is, of course, not all trusts and not just non-clinical managers who are at fault here. But if a 'clinical leader' can say "you may want to teach, but we may not need you to teach" then the managerialist, non-professional, instrumental employer-employee relationship is clearly becoming all pervasive and even goodwill now has a price.

The human resources module in my MBA programme, called managing people and organisations, was brilliantly taught and hugely revealing. The exam was a challenge but practising the theory is the real challenge. Treating the human resource as a cost that deserves trimming rather than an asset worth nurturing has wide-reaching implications which will ultimately be paid for by patients. To quote from an open letter to UK employees from the UK Commission for Employment and Skills, "The skills of our people are our best guarantee of future prosperity - and the best investment a business can make in challenging times. We must not pay the price of failing to invest in the talent on which our future will be built."

The healthcare future is predicated on the how the knowledge worker is viewed - asset first or cost first.

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