Updated: What Jeremy Hunt really thinks about NHS managers

Yesterday we accused the health secretary of saying the NHS needed more clinical leaders ‘because general managers see it is as their job to “whip doctors into line”.’

This was a misunderstanding of a conversation with HSJ after his speech to the NHS Providers conference. Mr Hunt was referring to a fashionable view held by some in the wake of the 1980s general management reforms inspired by Sir Roy Griffith’s review; not to current practice.

We have clarified the quotes in the news story and we apologise both to Mr Hunt and HSJ subscribers.

With this clarification made Mr Hunt’s speech can be seen in a different light – although many of the caveats raised in the original version of this editorial remain.

Before our readers worry that we have gone soft on the health secretary, HSJ does question the wisdom of choosing the NHS Providers conference to declare that the creation of “manager class” was a “historic mistake”.

NHS managers have a hard enough time without the health secretary questioning their very existence. He could easily have made his point about the need for more clinical leaders without pursuing a line which was already hackneyed when deployed in some of the many previous attempts to boost clinical leadership of the NHS.

And just for the record, it was not a “mistake”. Even if, as Sir Roy hoped, more clinicians did become involved in NHS leadership – there was also a need for strong “manager class” to improve the service’s efficiency and effectiveness. The NHS would be in a much poorer shape were it not for a generation of high quality managerial leaders, the recently-retired Sir Robert Naylor being one example.

Mr Hunt praised the work of hospital chief executives and acknowledged how their hard the job was. Better to have stopped there and moved on to his substantive point about deepening the pool of NHS managerial talent by attracting more clinicians.

The health secretary’s idea is not without merit. HSJ’s 2015 inquiry into the future of NHS leadership, chaired by Sir Robert, recommended that steps were taken to encourage more clinicians to take on senior management positions.

Mr Hunt’s proposals also have some attractive elements. He proposes to review the double jeopardy danger facing clinician managers who are exposed to both the NHS performance regime and professional regulation – another recommendation of the HSJ/Naylor review.

But the more important question remains why Mr Hunt will succeed when so many others – often in more favourable circumstances - have failed.

Mr Hunt’s policy-rich speech demonstrated a health secretary enjoying a notable second wind and determined to make his ideas stick. A speech on leadership could be seen as an attempted distraction from the pressing issues of declining finances and access that he can do little about. But the health secretary could reasonably counter that addressing NHS staff morale, given the events of the past year, showed he is prepared to tackle difficult subjects.

It may also be the case that the focus Brexit has placed on workforce issues throughout government might give Mr Hunt more bargaining power when he comes to seek the extra resources and regulatory changes which will be needed to realise his vision.

Mr Hunt pointed out that 54 per cent of NHS hospital managers are clinicians, compared to 74 per cent in North America. The main reason for that is the ability for clinicians, especially doctors, to make more money as managers. Is Mr Hunt prepared to see significant rises in the salaries paid to (clinically qualified) NHS managers?

Another barrier to greater clinical involvement is the politically-driven reporting culture in the NHS which is an anathema to medics in particular. This is a price we pay for a state funded system and reforming it to the degree which would make clinicians want to become involved in NHS management will be highly tricky.

A third factor is the risk/reward equation which is much more evenly balanced for clinicians than managers.

Fourthly, clinicians doing more management means clinicians doing less care. Is that really what Mr Hunt wants? NHS England medical director Sir Bruce Keogh has questioned the Holy Grail of more clinical managers, pointing out that there are often many more effective ways for medics to contribute to the performance of the NHS; whether though leading service development, pioneering new procedures, undertaking research and/or educating the next generation.

But perhaps the best test of Mr Hunt’s proposals are whether they meet the criteria suggested to HSJ by a wise (non-clinical) trust chief executive.

In his experience, clinicians will become involved in management if they believe it will result in better patient outcomes, improved staff satisfaction, peer approval and higher earnings.

One thing is for certain, without a “manager class” do much of the planning, encouraging and trouble-shooting Mr Hunt’s plans will come to naught.