For the NHS, getting serious about management is long overdue. Too often though, this is misunderstood. Many of us have an image, particularly where healthcare is concerned, of the 'men in grey suits', come to drown an otherwise capable organisation in bureaucracy. Obsessed with targets, uninterested in the organisation they manage, they care not for the doctors, nurses and patients who to them are merely numbers on an unnecessarily complicated spreadsheet.
Many are the onlookers who say "get these bureaucrats out of the way and let the doctors run the NHS". This is an attractive statement, outrageously wrong and doomed to failure, but attractive none the less when the alternative is the men in grey suits.
The NHS, or rather politics, the civil service and to some extent, the press have allowed this image to come about. The NHS is not currently managed well; this is a statement that most can agree on. There are good managers within the organisation, but they are not in a position to improve management culture and management maturity when so many of their colleagues are happy to keep their heads down and await the next inevitable restructuring project. This is one of the biggest issues facing the management of the NHS. Management is simply not allowed to mature because of externally imposed distractions. The dominant strategy of successive governments to repeatedly re-structure the NHS constantly distracts managers from real work in order to set up new organisations and relationships. Ideologically driven objectives like PFI and privatisation constantly restrict the ability of managers to even discuss the real issues, and instead they spend their time on contracts that they are not very good at drafting or policing. The structure of our healthcare system is not ideal, but structural problems will always be a problem in large organisations. Ideologically driven initiatives only help the ideologue. It is establishing mature management that needs to be addressed.
Management is not a dirty word, it is the ingenuity of mankind to solve problems and so, logically, this is where we should start. Every attempted restructure since 1973 has failed to address the root issues in healthcare, so let's admit that this is the case and try something different. Let us hold the structure for the time being, regardless of its flaws, so as to maintain a stable foundation and focus on real management.
But what of turning the NHS over to the men in grey suits? Well, put simply we're not. Good managers are not administrators, they are dynamic individuals adept at problem solving and organisation. The colour of their suits and their gender varies, but this has no bearing on their ability to successfully manage our healthcare system. It is these managers that need support from politicians, the civil service and the public. If the expensive restructuring and ideological initiatives are stopped and the investment is focused instead on improving management culture, then those in management who are currently coasting will be either empowered to achieve their full potential or they will be squeezed out and replaced by better people. With this new focus we could aim for measurably improved management maturity for the entire NHS.
Management is not an unknown: we know how to measure it, we know how to cultivate it and we know what to do to improve it. This is only achievable if governments leave their ideologies at the door, admit that restructuring has failed and focus on cultivating better management. Done correctly this could be the only way forward for free and effective healthcare in the UK.