opinion

YORKSHIRE TERRIER STEVE AINSWORTH

Do you remember that old Lonnie Donegan hit, My Old Man's A Mobile Domestic Refuse Operative?

Of course not. But that hasn't stopped dustmen (and for all I know, dustwomen) from hankering after a more highfalutin title for their calling.

The NHS is far from being immune to such folly. The rot set in 25 years ago and shows no sign of stopping. Before the great reorganisation of 1974, the NHS's most senior managers were content - and even proud - to call themselves secretaries and clerks.

Those titles were honourable and ancient: they could be traced back far beyond the birth of the NHS in 1948. But in 1974 something snapped. Maybe it was a hangover from the revolutionary spirit and iconoclasm of the swinging '60s that led NHS leaders to become discontented with their names. Suddenly, new titles were the order of the day: most of the sundry clerks and secretaries overnight became 'administrators'. Of course, not everyone was quick enough to jump on the bandwagon. The chief officers of the newly formed community health councils no doubt thought they had acquired some status with the title of secretary only to discover too late that the handle had become passe.

That should have been that, but of course it was not. The virus had escaped from the lab. Having acquired the taste for titular one-upmanship the race was soon on for bigger, better and more macho job titles. The introduction of general management in the mid-1980s soon provided the opportunity for real men to leave mere administrators behind and adopt the title of general manager - though not before some had informally experimented with the less grand-sounding, though invariably capitalised, 'Manager'. Others, for reasons best known to themselves, had unofficially tried out the title 'director' for size. Some, as confused as they were conceited, even doubled up, signing their correspondence 'manager and chief executive' or 'chief officer and director'. Strangely, neither 'manageress' nor 'womanager' ever proved popular.

I suspect that 'manager' had been purloined from the local DHSS office while 'director' was quite obviously borrowed from the head of the social services department. But these titles were short-lived as top managers searched the thesaurus for something which would truly reflect and encapsulate their worth and importance.

'Chief officer' might have done the trick had not CHC secretaries - finally rectifying their error of 1974 - suddenly surged forward and seized the high ground by laying claim to that particular title. The gauntlet was thrown down. As we now know, the leaders of health authorities, trusts and family health services authorities would soon eagerly adopt the title 'chief executive', a name which sounded both modern and energetic. It also conveniently freed the title 'director', which could then be awarded to second-tier managers. That particular tactic, perhaps not coincidentally, allowed NHS chief executives the pleasure of looking down on the now under- titled director of social services.

Even HA members are not immune to the temptation to call themselves by inflated names, apparently preferring the sobriquet 'non-executive director' to the official, though less dynamic-sounding, 'non-executive member'. This nonsense is, of course, not unique to the NHS. People like to sound important. The Royal Navy has more admirals than ships.

But in time the currency always becomes debased. It cannot have escaped anyone's notice that the most senior manager of each new primary care group will enjoy the privilege of calling themselves chief executive. That will never do. You read it here first: HA and trust chief executives will not long tolerate their status being undermined in this way.

On putting greens and in cocktail lounges across the land the search is now on for a name sufficiently tough-sounding for each local capo di tutti capi once again to be able to hold their head high at the Rotary club.

What should that new title be? Borrowings from abroad often provide excellent new words, though many of the best - El Caudillo, Il Duce and Der Fuhrer, for example - have been used up. 'Mandarin' has already, if informally, been adopted elsewhere. Maybe we'd better stick to English. Perhaps 'master', as in the once-familiar 'master of the workhouse' might do, though its feminine counterpart, mistress, may draw some objections.

I propose one final and definitive set of name changes, to be given statutory force in the NHS (Job Titles) Regulations 1999 after publication of a discussion paper. Two choices would stamp out the hubris once and for all: job titles should either be so inflated as to be transparently absurd or so modest they will be a permanent reminder to office-holders that they are no more than humble public servants.

Before the war, bored children would play a game which involved thinking up ever more outrageous titles for themselves. No one ever did better than 'vergistrator of the world'. Perhaps that would suit some; although Samuel Footes' 1854 literary invention, 'the grand panjandrum', is particularly apt.

But my own preference is for something modest and dignified. 'Almoner' has a respectable provenance, though 'rede' and 'scrivener' must be equally strong contenders.

Does it really matter? Yes it does. Had Shakespeare ever met Lonnie Donegan he might have come up with the lyric, 'a dustman's hat by any other name, still fits the same' - but I think there is rather more to it than that.