Back to Griffiths and management basics - manage the money, manage the medics: Health Policy Today 9 June 2009

Tom Smith, associate director of Health Policy Insight and chief executive of the British Society for Gastroenterology, looks at the silver jubilee of the Griffiths Report and clocks Andy Burnham's potentially record-beraking tenure as health secretary.

Reading the Health Service Journal this week made me think that NHS management is going retro: it's all about managing the money and managing the medics.

A lot of the news reports suggest the Department of Health is interesting in conflating the two into a single priority.

Look at the headlines. Political talks soon translates into the service. The clinical tsars are going to help engage doctors on the need to save money.  Given the way that policy shifts quickly, it would not be surprising if the work on quality metrics over the last year moves into identifying metrics that are indicative of efficient spending, away from attempts to best measure quality.

I get the impression that the NHS is going to be looking for a different kind of manager. Yet the irony is that the skills and qualities of the manager needed by the NHS are the same now as they were five, ten and even twenty-five years ago.

GENERAL MANAGEMENT IS 25 YEARS OLD
The changes that were ushered in to the NHS from the Griffiths Report appeared in practice 25 years ago. Looking at some of the headlines, it seems that some of the things he saw wrong with the NHS haven’t changed too much. General management has not yet achieved its goal.

The priorities were to:
-  Involve clinicians more closely in the management process.  Clinicians must participate in decisions about priorities in the use of resources.
- Ensure boards ascertain how well services are delivered by obtaining the experience and perceptions and patients and the community.
- Prevent decisions being made based on poor information
- Overcome the problem of the NHS lacking continual evaluation

The fundamental challenge faced by the new Health Secretary Andy Burnham is the same faced by his eleven predecessors: finding an accommodation between managers and medics.

Interestingly, in his previous stint as health minister (which did not last very long), Burnham started to articulate clinical engagement before the good Lord Darzi was appointed. He may be the right person to allow Darzi to take his engagement message further - though, as I say, there is a strong change that the Department of Health will want to give that message a special spin, linking the push on clinician-led quality to the 'innovation' needed to save money.

COULD ANDY BURNHAM SERVE THE SHORTEST TERM OF ANY SECRETARY OF STATE SINCE THE NHS WAS CREATED?
It remains to be seen whether Andy Burnham will make a good health secretary. He is in a competition to see whether he will be the shortest-serving in the history of the NHS.

Burnham's main rival for the title is Dennis Vosper: the Conservative health minister from January to September 1957, a stint lasting 9 months, 52 years ago.  Since then, only Alan Johnson since then has served less than a year (just a couple of weeks shy).

If Gordon Brown waits until the last possible date, Burnham might just avoid the record of the shortest stint as health secretary in the history of the NHS.

HEALTH MINISTERS SINCE THE NHS WAS CREATED
Aneurin Bevan (3 August 1945 - 17 January 1951)
Hilary Marquand (17 January 1951 - 26 October 1951)
Harry Crookshank (30 October 1951 - 7 May 1952)
Iain Macleod (7 May 1952 - 20 December 1955)
Robin Turton (20 December 1955 - 16 January 1957)
Dennis Vosper (16 January 1957 - 17 September 1957)
Derek Walker-Smith (17 September 1957 - 27 July 1960)
Enoch Powell (27 July 1960 - 20 October 1963)
Anthony Barber (20 October 1963 - 16 October 1964)
Kenneth Robinson (18 October 1964 - 1 November 1968)
Richard Crossman (1 November 1968 - 19 June 1970)
Sir Keith Joseph (20 June 1970 - 4 March 1974)
Barbara Castle (5 March 1974 - 8 April 1976)
David Ennals (8 April 1976 - 4 May 1979)
Patrick Jenkin (5 May 1979 - 14 September 1981)
Norman Fowler (14 September 1981 - 13 June 1987)
John Moore (13 June 1987 - 25 July 1988)
Kenneth Clarke (25 July 1988 - 2 November 1990)
William Waldegrave (2 November 1990 - 10 April 1992)
Virginia Bottomley (10 April 1992 - 5 July 1995)
Stephen Dorrell (5 July 1995 - 2 May 1997)
Frank Dobson (3 May 1997 - 11 October 1999)
Alan Milburn (11 October 1999 - 13 June 2003) - resigned
John Reid (13 June 2003 - 6 May 2005)
Patricia Hewitt (6 May 2005 - 27 June 2007)
Alan Johnson (28 June 2007 - 5 June 2009)
Andrew Burnham (5 June 2009 – present)