I’ve had one of those weeks. I was on the interview panel to appoint the chief executive of the NHS Confederation and within 24 hours we were the top story on BBC News at 10.
How does one convey to the public that bad things sometimes happen? Particularly when they are fed on the Daily Mail diet - which tends to find a public servant to blame whenever things go wrong.
“Separate pay scales and pension arrangements mean doctors who move into leadership roles expect to be paid twice as much”
In our case, much of the anti-stigma work on mental health issues has been undermined by tabloid headlines along the lines of “Paranoid schizophrenic released to kill”. Unlike the vast majority of the 500,000 people with schizophrenia in England, there are a very tiny number who will go to great lengths to do bad things; being bad is not a symptom of schizophrenia.
One in four of us will need help from mental health services at some point in our lives, but we are still in much more danger from people without a serious mental illness than those with one.
Clinicians for NHS management
In the same week, HSJ published its latest discussion on why more clinicians do not go into NHS management. Such debates are puzzling, because a significant number of successful NHS chief executives have clinical backgrounds - Heather Lawrence at Chelsea and Westminster foundation trust, Chris Butler at Leeds Partnership foundation trust, Patrick Geoghan at South Essex Partnership foundation trust, Claire Murdoch at Central and North West London foundation trust, and her predecessor Dr Peter Carter, now heading the Royal College of Nursing. Widen the net from nurses and immediately two ex-social workers crop up: Michael Scott, chief executive of Westminster PCT, and Cynthia Bower, chief executive of the new Care Quality Commission.
Could the term “clinical” have been confused with “medical” perhaps? If so, I can see the point - it is hard to produce a long list of doctors who have become successful NHS managers. Sir Jonathan Michael, previously of Guy’s and St Thomas’ foundation trust, and Dr Jane Collins of Great Ormond Street hospital are exceptions.
Membership of the discussion panel was interesting - of nine members, only one appeared to have a clinical background, and none had combined a clinical career with a move into top-level management.
Doctors and nurses
Royal College of GPs’ chair Professor Steve Field said doctors do not learn the theory or practice of management during their professional development. This is perhaps an important difference. For example, a nurse will manage others from the day he or she qualifies - first being in charge of a shift and then progressing on to 24/7 responsibility for a ward or service area on the same salary level as a junior doctor.
But at the heart lies motivation and perception. Separate pay scales and pension arrangements mean doctors who move into leadership roles expect to be paid twice as much as someone on a more traditional management career trajectory - or accept a serious pay cut.
Plus, leadership and management are not considered as intellectually demanding as clinical practice, and we do little to dispel this - I go back to the tabloid press.
This is why we were delighted to have such a strong field from whom to select the next person to run the NHS Confederation. Very well done to Steve Barnett for getting the job - you’ve certainly got plenty to do.