When managers rule

Written by the managing director of Sainsbury’s supermarkets, and three other businessmen, the “Griffiths report” (1983)1 unleashed a management revolution in the NHS. The report’s key recommendation were for a supervisory board to overview policy and strategy and a management board to implement it, together with regional, district, and unit general managers. In 2008, with the revolution well and truly over, the Health Service Journal ranked Roy Griffiths 12th in its list of the 60 most influential people in the NHS’s history for his role in setting NHS management on its current path.

After the report’s publication, the administrator of our district management team said something like “we will run the show from now on.” This was despite Griffiths’ recommendation that, consistent with clinical freedom for clinical practice, clinicians should be involved more closely in management and participate fully in spending decisions. At the time, Manfred Davidmann, who comments on styles of management, put his finger on one of the report’s problems: “What is completely missing from the inquiry team is grass-roots representation of any kind from all those who would be affected by the inquiry’s findings, namely from doctors, nurses . . .” He also correctly predicted how the new “managerialism” would play out over the next 30 years: “Management (that is executives) are apparently to provide patients and the community with what management and higher authority think is good for them.”2

My contention is that the imbalance between the power of managers and doctors, which Griffiths …