Oh ... for fuck's sake.
For. Fuck's. Sake.
Sigh. There I was this morning, browsing the day's news, and the Daily Telegraph chose to piss on the chips of my day, with an opinion piece for zombie for self-love Gerry Robinson, once again telling us how to fix the NHS. Because it really worked brilliantly the last couple of times.
In the latest tablets of stone down from the mountain, the self-satisfied sage has ascended to yet a higher level of NHS knowledge.
Gerry Robinson - Gezza - now knows that what the NHS needs is less managers. There are Too Many Managers, and Something Must Be Done.
If the NHS were Scientology, this would undoubtedly make Gezza a Level VII Operating Thetan or whatever it is ... you'll have to ask Tom Cruise - and good luck with that.
The money and numbers game
No, Gezza has had a revelation that what the NHS needs is less managers. And the reasons he offers? Ummmm.
Now, he does have the glimmering of a point when he says that we need "better" managers. Unfortunately, it's a bald assertion, with no definition following. Better at what, Gezza? Better at managing clinicians? Better at using data to benchmark performance and outcomes against comparable institutions nationally and internationally? Better at engaging with communities and making some progress into public health and Wanless's fully engaged scenario?
There is, quite simply, a blatant lack of clarity about what "better" management would be.
Moreover, the article is wildly factually wrong when it suggests that "In just two decades or so, the National Health Service has gone from having virtually no formal management structure, just administrative staff, to this week's announcement that out of a total staff of 1.36 million, 39,900 are managers".
Oh dear, oh dear. The 1983 Griffiths Report, which invented the profession of NHS management as generally understood today, is nearer three decades old. But even before that, the 1974 reforms that Wilson's second administration inherited from Heath were an attempt to create a mansagerial system. In the words of the NHS Official Historian Dr Charles Webster, the 74 reforms were "all done in the name of introducing state-of-the-art streamlined and efficient management”. The piece is seriously flawed by the second sentance.
Robinson's line is that everything wrong in the NHS - Mid-Staffs, Birmingham Children's Hospital, scndalous care for those with learning difficulties - is of the same cause as his 2006 experiences in Rotherham DGH FT, for the original BBC2 / Open University Can Gerry Robinson Fix The NHS?. He writes that while "the hospital staff, including management and consultants, was eager to make it a better, more efficient place. There was enormous goodwill and huge pools of talent. But there was simply no process to pull it all together in a cohesive, sensible way".
This is as if Gerry Robinson experienced a parallel NHS to the one in which PCTs, the Care Quality Commission (they're so nearly here now), the SHA, the National Patient Safety Agency, Monitor, the NHS Information Centre, the local MP, the local press etc can check up on how you're doing if you're an FT like Rotherham. Robinson's contention that "no one ever sits down and asks: 'How did it go last month?'" in simply preposterous.
Inadvertently, Gezza brushes past the crucial point that what is needed is a better, quicker intelligent and intelligence-based system to reveal comparative performance and outliers - such a system that would have outed Mid-Staffs, and indeed Shipman - in a trice.
That system would have to put a real value on data - probably financially - which is tricky without an effective IT system. It would need clinical confidence in and acceptance of its outcome measures. This will be a sea-change for the professions. It would require data and information to have a real value to everybody working in healthcare.
But if what we want is some cheap, ill-informed manager-bashing polemic, Gezza is our man.
Oh ... for fuck's sake.