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Observations Body Politic

Being an NHS manager is a fool’s errand

BMJ 2007; 335 doi: (Published 13 December 2007) Cite this as: BMJ 2007;335:1239
  1. Nigel Hawkes, health editor, the Times
  1. nigel.hawkes{at}

    A career in NHS management is a treacherous game of snakes and ladders

    When ministers talk about “the NHS family,” as they sometimes do, I’m tempted to wonder what their own family is like. Happy families are all alike, Tolstoy tells us, but every unhappy family is unhappy in its own way. The NHS family is unhappy in ways that perhaps even Tolstoy’s commodious imagination couldn’t comprehend.

    Doctors complain about the frustrations of working in the NHS and the erosion of professional autonomy. But their position is far more secure than that of senior NHS managers or, heaven help them, the non-executive members of trust boards. It may be unfashionable to take up the cause of the managers—so often the butt of doctors’ anger and politicians’ disdain—and nobody gives a toss about the fate of non-executives, but the way the NHS treats its managers and board members can tell us something about the culture of the organisation, and what it tells us is not good.

    A career in NHS management is like a game of snakes and ladders. The trick is to land on all the ladders and move up fast enough to escape from every job to a better …

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