Martin McShane: The money

Martin McShaneI was at a conference, struggling with one of those sharp sticks on which a bit of chicken was impaled whilst holding a plate of food in the other hand, when I noticed a short, bald bloke checking out the conference buffet. It was Greg Dyke.  He had come to talk to about 250 managers from across the East Midlands. We had a chat until the conference organisers realised he had arrived and then I returned to my efforts to separate the chicken and the stick.

When he spoke, I listened.  He didn’t use slides and his style was, I would describe as, conversational.  I didn’t make notes but he told stories that made me think about leadership, especially in the public sector.

When he left the BBC (a.k.a. got sacked) staff protested en-masse and he received over six thousand emails of support. He talked to us about what he had done and his view of leadership. Right at the start he said you can’t manage in a culture of fear.  The era of ‘telling’ people what to do is over. Society has changed. He talked about inclusive leadership. Leaders also need to be themselves; don’t try and be something else. If you are eccentric, then be eccentric, if you like a joke, then have a joke and if you are a miserable sod, then they shouldn’t have appointed you.

What caught my attention most though was his advice about money.  Don’t leave the money to the accountants, he said.  Accountants like to complicate it.  At the BBC they tried to make out it was a business. It isn’t.  The BBC takes the licence fee and spends it.  What he wanted to know was if the BBC was spending more than it received.

Nothing could be more relevant to the NHS right now. For a lot of clinicians and even a few managers, the money is something someone else has to worry about, usually the Director of Finance.  We can’t afford that attitude now. As commissioners the Treasury has given us a budget to improve health and health services and we are ruled by the Micawber principle. 

Commissioners, to a great extent, have little direct control over how that money is spent.  The people who spend it are professionals.  They can’t leave managing the budget to the accountants. Everyone is responsible and has to take responsibility.

Collectively we need to know how much we have to spend, how we are spending it and whether it is being spent in the best way possible.  The NHS is not that different from the BBC.  We have a fixed sum of money. If one professional is spending unnecessarily, inappropriately or ineffectively then they are denying someone, somewhere in the system, necessary, appropriate and effective health care.

As Mr Dyke says, we all need to understand the money and make it work to best effect.

Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.