Your humble servant: the spectre of Stalin looms over year end

• To: Don Wise
• From: Paul Servant
• Re: Managers’ Lib

Dear Don,

It’s that time of year. The last board meeting and the last financial report of the financial year. All the excitement of watching how the FD’s predictions about how the recovery plan, turnaround programme, savings targets and income generation schemes will all coalesce to turn 11 months of deficit into the predicted end-of-year surplus.

It’s that time of year when non-Stalinist SHAs decide whose surplus to raid to fund whose deficit, which in-the-loop chief exec to bail and which to let sink.

It’s not quite so simple this year though. Who should aspiring and ambitious managers suck up to? Who is going to be around to make good on promises? And how should those hoping for Uncle Joe Nicholson’s favour to flutter their way arrange themselves?

It’s a bit difficult to demonstrate your Stalinist skills by liquidating organisations and chief executive officers that the Department of Health has already said it will abolish.

It’s no threat to be sacked when you are already waiting for your redundancy notice - in fact, pay in lieu of notice would be rather attractive.

So all the incentives are lined up for senior managers to do what they think is right, rather than what they reckon the SHA thinks is expedient. This will no doubt prove overwhelmingly paralysing for some of our colleagues, but equally empowering for others.

But it might even put the most empowered on an equal emotional footing with their clinical colleagues, who have always claimed to only ever act with the most noble of motives, without fear or favour, in the best interest of…? What will doctors make of managers who are liberated? Rather than managers trying to deal with doctors who think they are?

And as for those doctors who are managers, well, pain is so close to pleasure, apparently.