A cull of sacred cows – managing the NHS like a supermarket. Or, bring back consensus management.

There are two lessons to be derived from the Stafford incident and the recent litany of other horror stories involving inhuman care and substandard treatment. These are that the healthcare professions are far too disengaged from hospital management; and that hospital chief executives have little understanding of, or interest in, the healthcare process. They are mainly concerned with kowtowing to their regional and Departmental bosses by meeting financial targets and ticking all the right boxes – the recent hullabaloo about the gagging of former NHS Chief Executive, Gary Walker, was a surprise; not because of the gagging dimension, a feature of the NHS that the Mafia would be proud of; but because here was an NHS general manager seemingly genuinely concerned about the healthcare delivered to patients
Both phenomena are directly attributable to a disastrous wrong turning taken by the NHS in 1984 when the style and ethos of supermarket management, promoted by Roy Griffiths, an erstwhile Sainsburys boss, was imposed in place of the consensus management model developed by management consultants, McKinseys, for the post 1974 reorganised NHS.
Over the 10 years of its existence, from my own experience at both district and regional levels in several parts of England, it worked well. This is not to say that consensus management was easy, involving as it did the major healthcare professions having to sublimate their individual differences and territorial imperatives, to see the bigger whole organisation picture, and to act in concert. It required a maturity of personality and outlook that some of the professionals involved, rather surprisingly, clearly lacked. However, it was I believed an entirely appropriate style of governance for the complex profession-dominated organisation that is the NHS. I am now persuaded, on the basis of the recent history of the NHS, plus my own personal experience as a health authority general manager in the 1980s, that it is the only appropriate style of governance.
However, the then Conservative government could not leave well alone and in 1984 it was summarily ditched in favour of supermarket style general management, in the wake of the 1983 Roy Griffiths report. This move was motivated by the desire of the government to get a better handle on NHS expenditure, though great play was made at the time of the alleged failure of consensus management, in some instances, to tackle major issues confronting it.
There were undoubtedly teething problems with consensus management but its really important achievement was that it succeeded, in most cases, in getting the major healthcare professions, and particularly the doctors, engaged in the management task with the predictable result that patient care and treatment were seen as the overriding priority and put centre stage.
Supermarket style management has no place in the NHS – how could anyone have seriously imagined that it did ? The way forward is through bringing back consensus management .The only change I would make is to add another professional to the team to represent the paramedical professions. And, experience indicates that members of such teams do need training. In 1974 we were all just thrown into it without any training or familiarisation; and in some teams it showed!

Paul Walker
February, 2013

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