Outsiders in their first few months in the NHS as, say, non-executive directors, are often aghast at the vast amount of information reporting that is required.
Then they get used to it and it becomes as normal to them as to the rest of us.
It becomes normal to be dragged down by the massive overload of information and reporting. Normal to get on with it, albeit with well-concealed snarling. If "less is more" ever means anything at the Department of Health (eg, during periodic re-announcements of "devolution"), it is pretty much meaningless at the moment. The policy pump keeps pumping - its engine as shrill as ever - more and more stuff that needs to be measured and reported on.
Managers need to be assertive and push back more against demands and processes which, if translated into the workplace, would look pretty close to bullying. Otherwise they get the flak from all sides - colleagues, the centre, other managers and the media - most of it unjustified.
Colleagues blame us for trying to implement everything from the centre without question or resistance. Now, they often have a point here. Most staff want to like their managers. But we are sometimes very good at giving them reasons not to. Pointless information collection also undermines the use of data for the right clinical reasons.
But what colleagues often miss is that most managers spend much time trying to shield clinicians and support staff from the worst of the system. Instead, they soak it up themselves - look at their hours of work and stress levels. Indeed, managers are the greatest victims of the bureaucratic urges that course throughout the healthcare system.
Then, managers get it from the people above, who regularly hammer them for failing to implement everything thrown at them. Take health minister Ben Bradshaw's reproachful exhortations to primary care trusts to do better and not let him down. In a centralised service I suppose this is reasonable.
However, it is also reasonable in such a top-down service to expect the centre to make at least a half-sincere attempt to do things that help the managers on the ground. At key moments the management by numbers approach of the government goes haywire. The despair and anger of PCT chief executives who had to tie up directors on fitness for purpose reviews - fairly useful though the review process was - when everything else was going bonkers, was largely because this exercise lacked any real-world proportion.
There are also the attacks from managers from other walks of life, such as the private sector or local authorities. How can those loons in the health service be so bad at managing even the basics, they ask? Such people often take a different view of the problem when they themselves have tried to work in the health service. More than once I have heard private sector people complain that they failed because their hands were tied, while still maintaining that public sector managers working in the self-same conditions are just incompetent.
My union is regularly asked to defend the latest "NHS managers gone mad" outrage in the media. It is hard but vital to convey the important points that managers are seldom engaged in mindless self-indulgence and that what might be red tape to me might be your life saved. Furthermore, very little of the mountains of guidance and information that we collect is completely without value. But what the media is often rightly quick to detect is a disproportionate amount of effort for any possible benefit. Managers need to avoid own goals and be fully prepared to defend and explain clearly why some information needs to be collected.
I was reminded again of what we are up against when the leader of the union for Britain's civil service mandarins asked me about red tape in the health service. (There is an irony in there somewhere.) By way of briefing, I dug out last year's The Bureaucratic Burden in the NHS, one of the NHS Confederation's consistently good reports and briefings. (Although the confederation could let itself go a bit with report names. Why not a series of punk-inspired titles reflecting our rage? The Bureaucratic Burden could have been Oh Bondage, Up Yours!)
Anyway, the report sets out the full horror: the number of organisations with rights to information and the number of separate data collections. But its most breathtaking finding is that 58 per cent of data collected could not be used for internal purposes, nor was it seen as useful. For "internal purposes" read "for the quality of care of patients and service users or the better management and development of staff". Fifty-eight per cent! Is it not a scandal that dozens of organisations including central government engage in a daily conspiracy to sabotage the managers and other NHS staff?
The answer is yes, but no one seems to care much. More self-help is needed. How about a little checklist to promote a healthy attitude to information?
Decide whether you work for a national health service of locally run organisations or for a mock civil service run out of Whitehall. If you decide for local, then be ready to push back on central demands for information.
A national organisation might have the right to get information but that doesn't mean it has to exercise it without challenge. Ask for the case for a request - particularly whether evidence resources used in complying will be proportionate to intended benefit.
Demand to know how any investment in time and effort collecting information will help your frontline teams.
Insist on feedback for you and any colleagues who helped collect information about how this was used, whether it will be collected again and so on.
Stop complying with unreasonable demands for information. Up yours!