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Without Prejudice...personal opinion

This fascinating article appeared on Dr Net. It is an explanation for the new breed of NHS manager and clarifies why they are being protected and promoted by the government and the SoS and the CE of the NHS exec. It seems this is the management for the future..so all that talk about the patient being at the centre of the changes was rubbish, or rather the lies told to the ignorant working masses, because in unitary organisations, managers must be allowed to manage, workers (everyone not in management) must obey, and of course there is no conflict in this perfectly regulated performance driven paradise for control freaks with untrammelled power. Anyone who disagrees in a unitary organisation is considered divisive and disruptive and not a team player.

The accentuations are mine.

What is even more interesting is that all these targets and performance measures are not used on the management who can be as inefficient and incompetent as they like! Furthermore, they are above criticism and blame, they are after all the MANAGEMENT, and this role alone makes them worthy of worship and respect and of course unquestioning obedience.

Who is going to be left to look after the patient or even have time to do so..once doctors comply with the Working Time Regulations, all the time spent on audit and governance plus of course maintaining CME and hours spent preparing and performing appraisal is going to reduce the time for direct patient care. And in order to provide the best care one must comply with the standards of clinical excellence which will slow things down further, and then juniors will be supernumary so no service provision from them, until they get to be consultants after only four years...me thinks this is melt down...still there will be all those graduates from the NHS university well skilled in governance, how to do audits and reading, having been taught by some of the "best" brains head hunted from HR departments..... that should do nicely for looking after sick patients. as long as they are flexible, that is all that matters.

Cynical, no!

What reason is there to be cynical or disillusioned? :-)

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Hood described new public management as comprising seven main points (1991, pp 4-5):

· Hands-on professional management in the public sector. This means letting the managers manage, or as Hood puts it ‘active, visible, discretionary control of organisations from named persons at the top’. The typical justification for this is that ‘accountability requires clear assignment of responsibility for action’.

· Explicit standards and measures of performance. This requires goals to be defined and performance targets to be set, and is justified by proponents on the grounds that ‘accountability requires a clear statement of goals; efficiency requires a "hard look" at objectives’.

· Greater emphasis on output controls. Resources are directed to areas according to measured performance, because of the ‘need to stress results rather than procedures’.

· A shift to disaggregation of units in the public sector. This involves the breaking up of large entities into ‘corporatised units around products,’ funded separately and ‘dealing with one another on an "arm’s-length" basis.’ This is justified by the need to create manageable units and ‘to gain the efficiency advantages of franchise arrangements inside as well as outside the public sector’.

· A shift to greater competition in the public sector. This involves ‘the move to term contracts and public tendering procedures’ and is justified as using ‘rivalry as the key to lower costs and better standards’.

· A stress on private sector styles of management practice. This involves a ‘move away from military-style "public service ethic"' and flexibility in hiring and rewards, and is justified by a ‘need to use "proven" private sector management tools in the public sector’.

· A stress on greater discipline and parsimony in resource use. Hood sees this as ‘cutting direct costs, raising labour discipline, resisting union demands, limiting "compliance costs" to business’ and is typically justified by the ‘need to check resource demands of public sector and "do more with less"’."

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Headhunt for NHS boardrooms

Health Secretary Alan Milburn is appointing headhunters to seek high-powered managers to bring a harder-hitting entrepreneurial culture into the boardrooms of the NHS in England. He wants young managers from the private sector for the boards of hospitals and primary care trusts. A ministerial source said, “The NHS has got to go out and headhunt. We need the best thirty-somethings to go and run services. We have to make sure that money is well spent and the NHS is well managed, especially now that the people are going to have to pay more tax." 3/3/3

Watch out all the incumbent 50-somethings...your days could be numbered! This is ageist and prejudiced, hasn't Milburn read the research on age and performance that a first year MBA student knows. More to the point has a 30-something really got the credibility and experience to run a large teaching hospital? Come to think of it has Milburn got the credibilty to be SoS for health with ignorant, discriminatory and insulting ideas like this.

© The Stealth Anorak 2003