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Rapid response to:

Editorials Christmas 2012: Editorial

When managers rule

BMJ 2012; 345 doi: (Published 19 December 2012) Cite this as: BMJ 2012;345:e8239

Rapid Response:

Re: When managers rule

Brian Jarman is right to highlight concern about systemic bullying in the NHS in England. His references to independent US evidence,corroborating UK experience (1) (2), in the context of the Mid-Staffordshire Inquiry, are particularly significant. Having myself given evidence to that Inquiry (3), I have good reason to believe that bullying, frequently associated with victimisation of whistle-blowers, is widespread and its impact under-estimated.

However, the reasons are complex and multifactorial. They cannot simply be attributed to one change, however significant, implemented thirty years ago. Many later developments (not least the introduction of competition, privatisation, constant reorganisation and relentless political targets) have contributed to unacceptable patterns of behaviour which most professional managers deeply deplore. Managers are frequently the subjects of such abuse and many have left the Service in consequence.

Jarman forgets that, since 1983, many general managers have been medically or clinically qualified. Since then, GPs have played key roles in commissioning and Medical directors have been universal. Why have they not challenged the obviously dysfunctional autocratic culture? The GMC has previously disciplined medically qualified managers who failed to protect the interests of patients. It must continue to do so. Existing voluntary management codes do require teeth but, in my view, can only be effective if NHS management becomes truly independent of the Department of Health.

Sadly, my own contacts with victims leads me to conclude that the BMA is part of the problem. It treats each successive case as a unique and isolated employment issue. If it were to reflect on its experience and publish aggregated data, preferably in association with other representative organisations, we might get a little closer to an accurate diagnosis of the evidence-based reasons for this deeply worrying problem.

1. www.patients

3.The Mid-Staffordshire NHS Foundation Trust Public Inquiry. Witness Statement of Professor David Hands. 27 Sept 2011.

Competing interests: Former Chief Executive of North Wales Health Authority and of NHS Trusts and health authorities in England. Married to a former Medical Director. Has worked with several individuals who have personal experience of bullying in the NHS

03 January 2013
David Michael Hands
Visiting Professor In Health Policy and Management
University of Glamorgan
WIHSC, Pontypridd, CF37 1DL