Martin McShane: The boa constrictor of bureacracy

Martin McShane Another request for “urgent” reporting pinged into my inbox today. It is the third or fourth in as many days. At least two were asking for identical information from different people, for different templates. The desire for central reporting is incessant and has not lessened one iota since May. If anything, it has increased. My team has become accustomed to it, fatigued by it, inured to it. We distribute the various templates, fill them in and fire them back off into the ether. They demand to know what we are doing about this and that and this again. They consume time and energy – time and energy which should be invested in working with clinicians who will make real change happen. Yet, even when there is the time and opportunity to work with clinicians, we have to call in the Office for Government Commerce, the National Clinical Advisory Team, the Co-operation and Competition panel and the Strategic Health Authority to mark our work, critique our work or simply stop our work. It is a vast and relentless bureaucracy with a centripetal force that has to be fully experienced to appreciate its impact.
Fortunately, this will all be swept away if the promise in the White Paper is fulfilled.


The most recent publication on the timetable for change sets out the complex changes required to move to a system where there is nothing between GP consortia and the NHS Commissioning Board . If the boldness inherent in the proposals put forward is realised, a lean NCB will require a radically new culture, a culture based on trust. The centre will need to let go and rely on regulation and incentives (predominantly market competition) to deliver the fiscal control and quality which the economy and public demand. This is a massive transformation for the NHS – and counter-cultural. It demands the demolition of bureaucracy.

Or is the boa constrictor of bureaucracy simply sloughing one skin and wriggling away to find another? If it emerges from the chaos and confusion of transition in a new guise, what will be the consequences? Bureaucracy feeds on acquiescence and compliance. It needs to crush autonomy and independence. Maybe autonomy and independence, after 60 years, is meant to be vanquished? I don’t believe that is the intent of the reforms.

The composition and functions of the NCB will critically determine whether we enter an era of ‘liberation’ or ‘restoration’. Watch that space.

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.