'If ministers want a decent view, they need to stand back'

In his last year in charge of the prison and probation service, Martin Narey reckons 70 per cent of his time was spent 'managing ministers'.

Since he left last October, the Home Office hasn't left the headlines, lurching from one crisis to another in the glare of the media spotlight.

In May, incoming home secretary John Reid loudly declared it not 'fit for purpose' (where did he learn that phrase?), ordered officials to publish an action plan and, two weeks ago, began a purge of staff. Plastered all over the tabloids, in best bruiser pose, Mr Reid's message seemed clear: it woz the civil servants wot done it.

In fact, announcing the action plan to the Commons, he reflected the point more succinctly made by Mr Narey last week, and admitted that it 'may' have been the case that ministerial involvement in 'micro-managing operations' damaged the strategy overall.

In fairness, Mr Reid may be less guilty than other ministers when it comes to meddling tendencies. While describing him as quick to demand actions and answers, those who have worked with him, both at the Home Office and during his two-year spell in health, say he prefers a couple of sides of A4 on any given topic to detailed policy briefings.

Compare this with Alan Milburn, his predecessor at health, whose only hope of protecting the service from his straying hands was to develop the concept of foundation trusts.

Yet, keeping with health, look at their legacies. For Milburn, the NHS plan, the result of consensus achieved across health and social care stakeholders, and a whole set of ticked-off targets. For Reid, a very expensive consultant contract, and what looks like unfolding chaos as successor Patricia Hewitt apologises, listens, and vows to press on with her inherited policy cocktail, while the unions band together and plan for a lively conference season.

A problem of unbalance

Unfair? Perhaps. After all, a significant part of the management community welcomed the introduction of many aspects of the current reform agenda - HSJincluded. And lest we forget, the reforms were intended to destabilise parts of the market.

But the pace of change - and the reluctance to let go of central control - has created a worryingly unbalanced system, and some seriously unhappy individuals. Primary care trusts are topsliced, while being told to strengthen commissioning; the independent sector is lured into plurality with contracts NHS colleagues could only dream of; organic change becomes wholesale structural reform, and the safest job going is that of a management consultant.

And so the government vows to listen even harder. Last week health minister Andy Burnham told HSJabout his plans for a government advisory group on reform, which will include Unison, the British Medical Association, the NHS Confederation and so forth. A bit like the modernisation action groups which created the NHS plan, except, of course, with regard to which came first.

They could save themselves some trouble. Days later unions, including the British Medical Association, Royal College of Nursing and Managers in Partnership, announced plans for a similar-sounding group, with many overlapping members. This time the advice is more likely to come via megaphones.

Mr Burnham also placed great emphasis on a tour of the country on which he has embarked, shadowing staff at 10 different organisations over the summer. His boss did a similar thing last summer, I seem to recall, though it was of course Princess Di who started the fashion.

When Mr Burnham says shadowing cleaners and porters has already given him 'an incredible perspective' on the health service, I believe him. My own experiences on both sides of the health service have done the same for me. But those subjective experiences are something I try to put aside when doing my job because I am aware that the anecdotal does not necessarily reflect the norm, and that if I want a decent view of the service I need to stand back a little. And I'm only reporting on the subject.

It worries me when Mr Burnham says he does not know how engaged NHS managers are with the current set of reforms - in particular the restructuring and increased private sector role in commissioning and provision - because he has only just started his tour and 'I've not yet spent a day with an NHS manager'. Whoever that lucky person is, there's a lot of responsibility resting on their shoulders.

Spurs to action

Sometimes the personal is political, and it takes the clear voice of an individual to shine a light on an issue: witness the Herceptin battles, the patient who tackled Tony Blair on 48-hour waits and inspired a white paper, and Sharron Storer's heckles in Birmingham over NHS funding ahead of the 2001 election.

Equally, there was an interesting case last week when a former Department of Health chief economist went public over his battle to get a prostate cancer treatment recommended by the National Institute for Health and Clinical Excellence.

As the man who had chaired one of the committees that created NICE, Professor Clive Smee knew how to fight for his rights: he went public when he found out that 11 other local men without his know-how had been denied brachytherapy.

So yes, the government needs to listen and respond to individuals, and in particular when it comes to righting wrongs. But if ministers want a serious overview of the whole of the NHS and get a sense of how the service 'feels', they may need to stand back - and call on a little help.

Luckily, there are several links in the chain between Mr Burnham and a hospital porter, often described as managers. If ministers do not want to spend their whole life on the open road, they may need to consider the art of delegation.