#PSEQUEL ALTERNATIVE PROFESSIONAL#
If managers are to lead the radical changes to services demanded by the NHS plan, they need time and space in which to acquire new skills such as work process control, developing and implementing care pathways, and changing the nature of professional work. The command and control style, a never ending stream of “must do” edicts, a “name and shame” culture, and the perpetual obsession with organisational restructuring can only detract from the ability of the NHS to deliver the plan. 6 It is the way that policy is being implemented: through endless prescriptions for change involving unprecedented micromanagement from the centre, which has the effect of constraining and undermining the ability of managers to manage. The unhappiness felt by managers does not stem from government's goals for the NHS nor from its diagnosis of the problems facing it, for managers still largely support the overall health goals and priorities set out in the NHS plan.
They display an unforgiving, top down command and control style of management (partly a reflection of the lack of trust and respect) in which unrealistic targets and objectives are showered down on managers, who are left feeling undermined and undervalued. Ministers talk the language of empowerment, devolution, collaboration, and support, but their actions speak louder than words. While NHS managers are used to being unloved by the public and health professionals, to find that their political masters have little regard for them leaves them isolated and disempowered. It blames them for the poor state of the NHS (for example, dirty hospital wards and long waiting times in emergency departments) and doubts their competence. The truth is that this government has never trusted or respected managers. The roots of the growing disaffection felt by NHS managers precede the current reorganisation. 5 What has gone wrong in the intervening years? In 1997-8 doctors and health services managers were reported to be largely supportive of the Labour government's plans for the NHS. Therefore ministers and their advisers should take this evidence of significant concern among the managerial community seriously. However, NHS managers have traditionally been stalwarts of public service, implementing government policy because that′s their job, regardless of any personal reservations they may have. 4 Governments often regard a degree of medical disapprobation as a sign that their NHS policies are generally heading in the right direction. Over 80% of general practitioners believe that the government's plans for the NHS are not achievable in the proposed timescale 3 and more than three quarters of managers consider that the “shifting the balance” reorganisation will delay delivery of the NHS plan. Few people outside the NHS management community seem to be aware of the exact nature and implications of these changes, which have their roots in growing public and political impatience with the quality of NHS services.įrom two recently published surveys 3, 4 it appears that both medical and managerial support for the government is at an all time low. But the reorganisation is steaming ahead regardless, with the aim of completing all the changes by April 2002. The consultation, which lasted six weeks, closed in early September and the government has yet to publish its results. Only the acute NHS trusts emerge from these changes relatively unscathed. 1 A consultation document, “Shifting the balance of power in the NHS: securing delivery,” 2 published in July proposed abolishing the executive regional offices of the NHS and two thirds of health authorities and creating new primary care trusts to take on a raft of responsibilities from health authorities. Having declared on taking office in 1997 that it recognised that the NHS had suffered too much structural reform, the re-elected Labour government has embarked on the largest, and least debated, reorganisation of the NHS for two decades.
0 kommentar(er)
