Crisp to rescue of middle managers

The plight of middle managers caught between the need to deliver government targets and the resistance of the medical profession is to be directly addressed by NHS chief executive Sir Nigel Crisp.

He also suggested that the government is likely to take a more flexible approach to target-setting in the future.

Sir Nigel was speaking exclusively to HSJ after last Thursday's medicine and management summit organised by the NHS Confederation and the royal colleges. Around 80 senior figures met to discuss how the relationship between managers and medics could be improved.

The summit addressed the difficulty faced by middle managers when pressure from above meant trying to persuade unwilling doctors to work in a way that would deliver targets, only to have the clinicians appeal over their heads.

Sir Nigel said the summit had reinforced his impression that 'the real problem is between middle managers and doctors'.

'Middle managers are carrying a lot of problems without having the seniority to resolve them.'

He said he would be taking 'practical' steps to resolve the problems and to ensure more positive relationships were developed at a more junior level.

Targets were a focus of fierce debate at the summit. There were calls for them to be evidencebased, applied to the whole patient pathway and implemented more flexibly, preferably at a local level.

Sir Nigel claimed that the majority of targets in last autumn's planning and priorities document, such as those in the national service frameworks, had strong medical support, but acknowledged that there was considerable controversy over waiting-list goals.

Asked about the proposals raised at the summit, he said there would be no change in policy on delivering the targets due by March 2005.

However after these had been met, the government would have 'different expectations' about how targets would be set and implemented and would be open to the kind of suggestions made during the summit.

Sir Nigel's comments come in the week that former junior health minister Lord Hunt criticised the government's record on targets.Writing in this week's HSJ, he says: 'Some targets are essential... But we set far too many, and the beleaguered NHS is still suffering under the weight of it all.'

At the summit: managers and medics plan programme to heal rift

NHS Confederation chief executive Dr Gill Morgan said the managers and clinicians summit group - which includes HSJ - would develop the work undertaken at the meeting in three ways.

The analysis of the problems would be mapped out and a statement of the principles which should govern relationships between doctors and managers agreed.Finally, a work programme 'of specific actions'aimed at improving relationships would be developed.

It is hoped the final document will be endorsed by all the organisations involved in the summit, including the Department of Health.Professor Peter Hutton, chair of the Academy of Medical Royal Colleges, said the meeting had identified 'a commonality of opinion' between those present.

But he said many NHS managers did not demonstrate the sophistication needed to improve quality and throughput without disenfranchising the medical workforce.Professor Hutton said a better solution would be for consultants to redefine their roles in a way which delivered the necessary changes - an approach which 'would prove unpopular in some elements of medicine'.

The British Medical Association had officially pulled out of the meeting (''Show must go on'after BMA pulls out of doctor-manager summit in media access row', news,13 March), but there were a number of BMA representatives present.Dr Paul Thorpe, BMA junior doctors committee chair, said he had 'mixed emotions'about the meeting.He felt there was 'a will to air the problems', but also a desire to 'accentuate the positive too much'over potential solutions.