I read the King’s fund paper on management in the NHS. It should be read widely. Some politicians and professionals understand that successful organisations have good management. Some even understand that bureaucracy is a product of a set of rules. A bureaucrat can’t be a bureaucrat without those rules. The rules I have to work to frequently irritate and frustrate me. I find the rules on procurement byzantine, lengthy to negotiate, and so mechanistic and transactional that using them to deliver transformation, which requires flexibility, adaptability and nimbleness, is counter cultural to the whole process. It’s a bureaucracy which we have to try and manage. We are given it. We don’t create it.
I am, however, now discovering what it is like to try and manage without any rules.
We have now aligned senior, very senior, managers with the GP consortia within our newly formed cluster. The top team of the PCT has been disrupted; divided to give the consortia skilled and experienced managers to support them in delivering (so that they don’t end up with a massive financial headache when authorised) and to support their development. What rules were we given for this? None. There is no human resources framework to apply. Consortia don’t have any statutory standing until authorised. We have managed it so the consortia can get on with the job at hand. We don’t want to frustrate their ambition and motivation. It has been done with goodwill.
The new, lean, cluster team met with the chief operating officers, as they are now called, to discuss how we are all going to work together in the coming months to realise the potential which we see in the fledgling consortia. The cluster needs to support the consortia, whilst assuring itself that the progress we have made with quality is not lost and, wherever possible, is improved. We all agree that to do that we need to align and assign PCT staff out to the consortia. Again, there is no national HR framework. We are working with the staff and trying to navigate our way through uncharted territory. What rights will people have who are assigned to consortia – which have no legal status at present? How will transfer of undertakings protection of employment (TUPE) apply? How do we get people to continue working for the cluster when it appears to have no future? What about the NHS Commissioning Board? Have I mentioned commissioning support organisations? Which of these organisations will have the benefits associated with working for the NHS?
Does it matter? Of course it does. There are staff in our organisation who can’t get a mortgage because they can’t explain what their job will be or whether they will have one. They are trying to work in a state of uncertainty. Why, when they are derided as pen pushers and bureaucrats should they be focused on maintaining quality and delivery in the NHS? What makes me proud to be associated with them is that most of them still are. They have values and goodwill which are being sorely tested but, for now, I feel are holding.
The management in the NHS is still leading but, I have discovered, sometimes rules are a good idea.
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.