I was taken recently by the findings of a study of careers of NHS managers with 25 or more years experience. The findings, from Royal Holloway and the University of Surrey, are especially interesting because the careers of many of the managers interviewed pre-date the introduction of general management into the NHS in the 1990s.
Although historically public sector management research shows managers frequently complaining about continual NHS restructurings (OK, less so recently), the experienced managers interviewed accept this as the reality of public service context. A useful finding that offers some perspective given the likely change of government next year, and the ‘will they-wont they’ debate about restructuring. Incidentally, is there anyone who doesn’t seriously believe public services can survive in their current form given the economic pressures? From another perspective if there’s one group who should be the embodiment of change then isn’t it managers? If they’re not then perhaps general management for the NHS shouldn’t have been recommended all those years ago by Roy Griffiths. His report, by the way, is still the pithiest and best piece of NHS management guidance ever produced. Oh that all policy makers could write like him.
What is more interesting from the Holloway/Surrey research is that that the introduction of competition in the 1990s and Labour’s 1997 reforms were less traumatic for the managers in the study. The researchers suggest that over time managers have been increasingly sensitised to policy shifts and to adapting their roles accordingly. This finding is not to be dismissed lightly because as the NHS leaders of change and policy implementation, managers are probably more resilient and pragmatic than they are usually given credit for. Finally, and I think most importantly, the research underscores that managers do strongly associate themselves with the value and ethos of the NHS. Consequently, in an era of, not unreasonably, greater emphasis on clinical engagement, the experience and knowledge of managers should be of equal importance in formulating and implementing new policies and proposed change. A useful message to remember as the 2010 government emerges.