Re: When managers rule

28 December 2012

In his incisive article, Professor Jarman omits a key word that explains the current predicament of the NHS. That word is 'corporate'.

The founding of a huge organization such as the NHS inevitably led to the need to manage its workers, hence in 1947 the process of doctors becoming ‘de facto’ civil servants commenced. The Griffiths Report was an important waypoint in the process, ensuring that the focus of a doctor’s attention would be on corporate goals defined mainly by government and enforced through non clinical managers. As Stalinist comparisons abound in any discussion on the NHS (and are mentioned by Jarman) this bears some comparison to the role of embedded non military trained commissars in second world war fighting units of the Soviet army. Commissars were responsible for strategy and discipline, often countermanding senior military officers; their presence was not widely regarded as a success.

A corporate management system can be effective: witness this decade’s dramatic waiting list reductions that have required both managerial and clinical resolve. But the replacement of a doctor’s duty to his patient by corporate aims determined by those with no professional responsibility to a patient was always going to be a recipe for disaster. Particularly so if the focus of these aims was on the survival and health of an organisation rather than the patient served by it.

It is unfortunate in this context that individual opinion is frequently seen as an affront to corporate aims. The net result of this is that professional responsibility is subjugated. A similar corporate culture has in the last two decades defined two other great organisations whose ethos was rooted in that of public service: the BBC and the Police Force.

Competing interests: None declared

Christoph C Lees, Consultant

University Teaching Hospital, Cambridge

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