Politicians, Delusional Managers and the Future of the NHS: Have NHS Leaders Failed to “Speak Truth unto Power”?
11 Jan, 17 | by Iain Brassington
Guest Post by David Lock QC
[NB: This is a slightly longer version of a post that appeared on the BMJ blog earlier today.]
Politicians, delusional managers and the future of the NHS: have NHS leaders failed to “speak truth unto power”?
This blog is not a rant – well not too much of a rant. It is an expression of serious frustration about the way the NHS is run and about the willingness of senior NHS managers to become complicit in dishonesty. It also needs to acknowledge the brave role of some in the NHS – particularly in NHS Providers – who keep telling it as it is and being decried for doing so.
Everyone at the frontline knows the NHS is running on empty. The more perceptive know that more money for the NHS alone will not improve services for patients. But – and this is perhaps the unpopular “but” – NHS senior managers ought to accept their share of the responsibility for the present crisis. The problem is the failure of NHS managers to “speak truth unto power” to those above them and to our political masters for too many years. Long before Sir Ivan Rogers used the phrase, a 2015 FCO blog explained the centrality of this concept as part of public service as follows:
The UK Civil Service doesn’t have an official motto – but if it did, it would almost certainly be: “speak truth unto power”. It’s a maxim that’s in the blood of good civil servants, even if they know that it won’t make their lives any easier. The best politicians learn to cherish civil service advice which points out the flaws in their arguments. The worst surround themselves with sycophants who create a micro-climate which wraps a warm embrace around their worst tendencies.
But, this principle appears respected in the breach in the NHS. The £22bn efficiency challenge came out of nowhere and yet became an article of faith. Of course, it has not been delivered and was never going to be delivered, but the planning process has continued in a parallel universe where no one has the courage to say “Actually this is nonsense – a public service has never delivered these efficiency savings and the NHS will not do so”. So the fiction is maintained that this is what the NHS has to do by 2020. But, of course, we are now in 2017 and so there is precious little time to deliver the undeliverable.
Secondly, the fiction is that the present government is putting an extra £10bn into the NHS, as well as promising an extra £350m per week as a Brexit dividend. The £10bn claim was never accurate. No set of “true and fair” NHS accounts could ever include the £10bn claim. The £350m a week claim was made for votes, not for spending. And yet who in the NHS has held the government to account for either promise? more…