The Changing NHS

It’s not surprising that there is a gap. After all many NHS managers spend their working lives entangled in meetings discussing administrative systems and processes, monitoring targets, reporting service activity and financial information etc. It’s easy to forget that the NHS is supposed to be mostly be about caring for people.

However, this divide has probably grown in the last 10 years. It has been fuelled by a rise in overt mangerialism brought in on the coat-tails of Blarism and the extra investment piped in since 1999. It has been made worse recently, as a result of the much publicised financial pressures in some Trusts, with the consequent threat of job losses amongst clinical staff, together with managers seemingly pre-occupied with structural changes in PCTs and SHAs.

This ‘mind the gap’ problem was first brought to my attention by Sholom Glouberman when he was working at the Kings Fund in the mid 90s. In a great article called Managing the Care of Health and the Cure of Diseases, Sholom and Henry Mintzberg proposed that effective healthcare systems were difficult to maintain because they consisted of 4 fairly distinct domains: Community (board), Control (managers), Cure (medics) and Care (nurses). Successfully integrating these 4 worlds remains a very tricky task. 

Reading Valerie’s blurb about the set has reminded me of my time spent working for a not-for-profit healthcare system in the States in the early 90s and how struck I was by the strength of the caring ethos that permeated the organisation.

I can think of 3 reasons why this was the case. Maybe we could learn from them?

1) Managers naturally and actively sought a strong alliance with nurses. This was mostly because the medics (specialists) were not employed by the hospitals and therefore the managers found it very difficult to get them engaged in organisational performance issues – naturally they looked to the Nurse managers instead. “Getting the Nurses on board” was a more common cry than “Getting the docs on board”;

2) The ‘delivery system’ had a corporate board and then each of the 5 hospitals had a local board. Almost all the financial reporting was done to the Corporate board, leaving local boards relatively free to concentrate on service lines and customer and staff care issues;

3) The organisation invested enormous effort in identifying the core values held in common by the 12,000 staff and then sought to systematically operate in ways that were congruent with them  Unsurprisingly compassion and respect were 2 of the 4 core values held by the staff (and this included senior managers!). Note this approach is very different from the one most often used in the NHS, where a set of managerially or politically devised values are imposed on employees and then the organisation either forgets about it completely or seeks to control behaviour accordingly.