MANAGEMENT FROM MARS 2 - THE NATIONAL HEALTH SERVICE

Politicians as managers

Gerry Robinson, one of a very few British top managers from the top drawer, has been taking a look at the NHS. Robinson was at his best when leading complex organisations to become effective service providers, so he knows a thing or two about service businesses.
He was scathing about the strategic leadership of the NHS, which of course involves politicians. In essence, he vividly described a scenario in which political leaders cause chaos by, he said:

• Constant fiddling with priorities,
• "Initiativitis" - a constant stream of restructurings and new initiatives, each building further confusion on that of the previous ones,
• A complete lack of understanding of the devastation their behaviour wreaks on the unfortunate staff at the front line, and why this occurs,
• Setting targets from the top that are completely disconnected with operational reality, distort local priorities and are all too subject to fiddling,
• An unrealistic faith in the private sector as being better than public enterprise,
• And a Soviet approach to designing mega-systems of enormous complexity that always fail to deliver much trumpeted benefits. Why, Oh Why, asked Robinson, did the NHS not build its all-singing IT system from the ground -up, ensuring that local managers had good system development support and that local systems could be networked - rather than telling everybody to wait until the grand mega-system was unveiled - 10 years late, or never, and at a wasted cost that could have paid for 30,000 more nurses.
  This smacks of gross centrist incompetence that matches the old Soviet Union, and we all know what happened to that.

Robinson went on to castigate politicians for their obvious dogmatic determination to introduce the private sector to compete with the NHS, using the example of the Yorkshire town of Rotherham. The regional Health Authority, in line with government policy, was building a new primary care centre at a cost of £12 million, less than 2 miles from the existing very efficient NHS hospital. When questioned, the CEO of the regional body had no clear idea of what it was going to do and what impact it would have on the hospital. Gerry Robinson pointed out that easily available care and diagnosis for minor ailments (which he surmised was the mission of the new centre) could have been provided by very small additions to the existing hospital's A&E facility and using the expensive technology already installed in the existing hospital. No need to duplicate overheads, systems and all the rest.
The new centre would probably take away one third of the simple cases that came to the hospital, thus leaving it with the expensive difficult cases. This would in turn make the hospital more expensive, so that it would be penalised for not meeting top-down targets.
Last, he visited a private surgical clinic run by a surgeon who had previously been a star with the NHS hospital and who had left, not because he disliked the NHS, but because he was not allowed freedom to develop the service with the flexibility he wanted because of NHS rules (not hospital bureaucracy).
The surgeon said that his private service was far more efficient than the NHS.... but only because they were able to cherry-pick the simple cases, leaving his previous NHS department with all the complex work. This, in his opinion, had two dire effects - it made the NHS hospital appear less efficient than it could be and it exposed the hospital to further predation by a rapacious private system. It seems that the private sector is being induced to compete with the NHS on unequal terms so that it can progressively suck the lifeblood from it.

Well, what would you expect?

These days, the media and public have cast prime ministers in the roles of Chief Executives, departmental ministers as divisional MD's, and are more than anxious to blame them for what are seen as executive failings. Ministers in turn are not rushing to explain that their role is not executive, presumably because they fantasise that it is or it might be construed as weakness.
This is a ludicrous state of affairs. Here's why:

• Ministers are so far from the operations as to be totally disconnected from front-line reality. Their understanding of what really goes on is therefore dangerously tenuous. They are the most non-executive of non-executive chairmen.
• This situation is exacerbated by the fact that they revolve jobs frequently, so getting no real chance to learn anything in depth about their portfolios. So, they are both distant and ignorant, not a good recipe for executive success.
• It is further worsened by the fact that contemporary ministers are more likely to have come to the top via policy research, PR or some other non-managerial activity. Most of them haven’t the experience to manage the proverbial whelk stall.
• Ministers have clung to armies of management consultants to advise them on implementation. The last thing management consultants do is implement - they analyse, write reports and advise. This must be the most expensive game of the blind leading the blind ever invented - consultants cost government more than £2 billion annually.
• Finally, and alas, many ministers bring dogmatic baggage to their jobs - these days a sublime belief that free markets and competition will solve all problems. This dogma, like most, is untainted by the need to produce any empirical evidence that they are not peddling nonsense, so they plough on, uninterested in whether their beliefs have any foundation.

Readers are invited to find a better example of a disaster in the making...