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| Why would doctors and nurses put themselves through the ordeal of NHS management? Why would doctors and nurses put themselves through the ordeal of NHS management? | |
| (about 1 hour later) | |
| Jeremy Hunt’s attempt to distract attention from the growing problems across the health and care system betray a poor understanding of NHS management. | Jeremy Hunt’s attempt to distract attention from the growing problems across the health and care system betray a poor understanding of NHS management. |
| In his speech to the NHS Providers’ conference this week, Hunt asked whether the NHS “made a historic mistake in the 1980s by deliberately creating a manager class who were not clinicians”. | In his speech to the NHS Providers’ conference this week, Hunt asked whether the NHS “made a historic mistake in the 1980s by deliberately creating a manager class who were not clinicians”. |
| At its worst, NHS management is a reputational meat grinder | At its worst, NHS management is a reputational meat grinder |
| To encourage more clinicians into management, Hunt promised to review whether doctors and nurses are put off by the fear of sanctions from their professional regulators if things go wrong, and to look at whether doctors should be able to choose clinical leadership as a specialism. These would be welcome changes, but they would do nothing to address the fundamental reasons why so few clinicians go into management. | To encourage more clinicians into management, Hunt promised to review whether doctors and nurses are put off by the fear of sanctions from their professional regulators if things go wrong, and to look at whether doctors should be able to choose clinical leadership as a specialism. These would be welcome changes, but they would do nothing to address the fundamental reasons why so few clinicians go into management. |
| At its worst, NHS management is a reputational meat grinder. A combination of extreme financial stress, dysfunctional local systems and a tough inspection regime that can come to simplistic judgments means that a doctor or nurse who had been secure in their clinical role and spent perhaps three decades building their good name can see it pulled down in a matter of months. | At its worst, NHS management is a reputational meat grinder. A combination of extreme financial stress, dysfunctional local systems and a tough inspection regime that can come to simplistic judgments means that a doctor or nurse who had been secure in their clinical role and spent perhaps three decades building their good name can see it pulled down in a matter of months. |
| No ministerial warm words will overcome the impression made when senior clinicians see respected peers such as Mark Newbold at Heart of England foundation trust or Keith McNeil at Addenbrooke’s quitting as chief executives. Managers, like clinicians, accept accountability as integral to their role. But when an institution is perceived to be in difficulty, treatment of the leadership often amounts to public humiliation. | No ministerial warm words will overcome the impression made when senior clinicians see respected peers such as Mark Newbold at Heart of England foundation trust or Keith McNeil at Addenbrooke’s quitting as chief executives. Managers, like clinicians, accept accountability as integral to their role. But when an institution is perceived to be in difficulty, treatment of the leadership often amounts to public humiliation. |
| Moving into management almost inevitably means clinical skills and knowledge will atrophy. While a handful of people have managed to combine the two roles, the likelihood is that you quickly lose track of the latest developments in your specialism and your technical expertise declines. Within months, the benefit of years of experience and practice slip away. | Moving into management almost inevitably means clinical skills and knowledge will atrophy. While a handful of people have managed to combine the two roles, the likelihood is that you quickly lose track of the latest developments in your specialism and your technical expertise declines. Within months, the benefit of years of experience and practice slip away. |
| Hunt said he will look at this issue, but no policy sleight of hand can change the fact that going into management means slipping down the pecking order of the profession that you love. | Hunt said he will look at this issue, but no policy sleight of hand can change the fact that going into management means slipping down the pecking order of the profession that you love. |
| Clinicians are problem solvers. Applying judgment built on foundations of evidence and experience, the job satisfaction comes from taking an action that benefits the patient. That inherent reward of making a difference is enough to trump all the stresses and difficulties and brings staff back day after day. | Clinicians are problem solvers. Applying judgment built on foundations of evidence and experience, the job satisfaction comes from taking an action that benefits the patient. That inherent reward of making a difference is enough to trump all the stresses and difficulties and brings staff back day after day. |
| Managers have the stresses and difficulties, but too often the job satisfaction is elusive. The sales pitch to clinicians is that you can go from benefiting an individual patient, ward or department to improving an entire organisation. But with unstable finances, growing demand and intense central scrutiny, management often seems characterised by a lot of responsibility and too little power. For many clinicians, it is difficult to see how a management role would provide more job satisfaction. | Managers have the stresses and difficulties, but too often the job satisfaction is elusive. The sales pitch to clinicians is that you can go from benefiting an individual patient, ward or department to improving an entire organisation. But with unstable finances, growing demand and intense central scrutiny, management often seems characterised by a lot of responsibility and too little power. For many clinicians, it is difficult to see how a management role would provide more job satisfaction. |
| There is still work to do in ridding the NHS of the “us and them” attitude to managers of too many clinicians. Around the country there are a growing number of imaginative schemes to help junior clinicians and managers understand each other’s worlds and develop mutual respect for the contribution that each makes to patient care. The massive expansion of leadership training for clinicians in recent years is similarly important in clearing out antiquated perceptions of management. | There is still work to do in ridding the NHS of the “us and them” attitude to managers of too many clinicians. Around the country there are a growing number of imaginative schemes to help junior clinicians and managers understand each other’s worlds and develop mutual respect for the contribution that each makes to patient care. The massive expansion of leadership training for clinicians in recent years is similarly important in clearing out antiquated perceptions of management. |
| But nothing will encourage clinicians to take up management roles more than a belief that the job is doable, and that they will not be scapegoated for failing to solve problems over which they have little control. | But nothing will encourage clinicians to take up management roles more than a belief that the job is doable, and that they will not be scapegoated for failing to solve problems over which they have little control. |
| The gradual shift towards managing local health services as systems rather than organisations is a crucial step in achieving this. If government and the central bodies want to see more clinicians in management, they need a determined effort to clear the obstacles out of the way so managers can spend more time leading improvement built around the needs of patients, and less time managing bureaucracy and crises. | The gradual shift towards managing local health services as systems rather than organisations is a crucial step in achieving this. If government and the central bodies want to see more clinicians in management, they need a determined effort to clear the obstacles out of the way so managers can spend more time leading improvement built around the needs of patients, and less time managing bureaucracy and crises. |
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