Jon Restell on why managers are worth it

The language used by ministers launching the white paper to describe managers did just that. Whether intended or not, it has damaged management throughout the service, and added fresh risks to those already in the coalition government’s plans for the NHS. But recriminations are pointless. All parties should work together to swiftly pull managers into the vision for the future.

To begin, strong feelings need airing. Health secretary Andrew Lansley’s approach to giving leadership to managers is unorthodox, like King Herod’s approach to childcare. Why are we so upset? After all, Labour ministers operated just above freezing point with us.

But the public contempt and denigration from the new political leaders was unprecedented. They went too far. Dozens of managers have told me how bad it makes them feel, from pain to cold fury.

Why do NHS managers deserve personal attack? Talented, dedicated professionals who slog their guts out, make the system work for patients and colleagues, tackle endlessly proliferating demands, love their jobs and services, put in the discretionary effort on which the health service relies, believe they make things better. In other words, typical NHS people.

Other voices have injected balance, especially the British Medical Association. I used to write rude things about Laurence Buckman, chair of its GP committee; now I keep his picture in my wallet.

But the damage is done, and well beyond primary care trusts and strategic health authorities.

No one has been more hurt than the clinicians in management. Many good leaders have had enough, and with an eye on the assault on pensions, intend to jump ship.

Matters are starkest in SHAs and PCTs. The slow death of PCTs and the “no one likes you” message has nailed morale to the floor.

Good people with marketable skills are heading for the doors. But they are supposed to stay, see through the transition, stop finances screaming out of control, deliver the quality, innovation, productivity and prevention agenda (QIPP), launch new structures, oh, and halve their number and take a political kicking. Tempting, isn’t it?

This is grim. But fences can be mended.

First, change the terms of the debate. Don’t use “management” and “bureaucracy” interchangeably. Better still, stop talking about “bureaucracy” at all, a word with no concrete meaning, used for anything you don’t want to do or anyone you don’t like. And ditch the other half of the double act - “the front line”. It is nearly as meaningless.

Instead, debate more precisely what we want and don’t want from managers. Be creative. Use some - heck, all - redundancy cash to invest in the management and leadership skills of NHS staff.

Most of all, accept that good managers are essential for good healthcare.

As health select committee chair Stephen Dorrell recently said, if a company board announced it needed no managers, shareholders would pass a vote of no confidence.

Second, rethink the timetable. Are we sure about frontloading a 46 per cent management cut at the start of torrential change? Why not take savings from the new structures, when - if - we get there?

Third, treat managers as a valuable resource you would lose only with a gun pointing at your head.

Devise an exemplary HR framework to create reasons to stay and commit. Why the long faces about the transfer of undertakings (protection of employment) regulations? Many of these managers are exceptionally good. Harness them.

Fourth, if we must knock the house down to rebuild, rather than mend the roof and replace the windows, then learn the lessons of the recent past - size, talent pool, resources, freedom etc - to avoid GP consortia being the whipping boys of 2016.

Finally, use your own eyes. Doubt what managers can do? Go to Rochford Hospital, part of South Essex Partnership Foundation Trust. Excellent managers, efficient and innovative systems of care, strong clinical leadership, training, development and engagement for all staff, massive community involvement, dignity and respect for the people who use the services. I dare you to find better people delivering better services.

Jon Restell is chief executive of Managers in Partnership.