Column

Sack the manager!

Another Saturday. Another humiliation. Another difficult post-match interview.

Desmond: Well Brian, 0-4 to Oldham Athletic. It is looking pretty desperate for you. Many are saying relegation is inevitable now.

Brian: Don’t write us off while there are games to play. Our purpose is to win trophies.

Desmond: If you don’t mind me saying, that’s rather beyond your side this season.

Brian: It is not clear if winning trophies is our primary purpose.

Desmond: I’m sorry? I don’t quite follow your argument.

Brian: Listen to me, young man. I’ve won more cups than you’ve got on your Welsh dresser. I can speak with particular authority about whether we are achieving our purpose or not.

Two days later the club announces Brian’s departure by ‘mutual agreement’. Everyone was expecting it. No-one can manage any organisation properly when so obviously stressed and confused. No-one, that is, apart from a health service manager.

Health service managers seem to be an exceptionally hardy breed. Unlike the managers of football clubs they seem able to keep their jobs even when they make plainly ludicrous claims. Here, for example, is what the Institute of Health Services Management has published in its latest report (Future Health Care Options), which was put together with the help of at least seven NHS chief executives and two senior academics. Any resemblance to Brian’s ramblings of is entirely intentional:

Section 7.14 ‘... the purpose of the NHS is to improve the physical and mental health of the population and to prevent, diagnose and treat illness’

Section 1.2 ‘It is not clear if the improvement of health is, or should be, the primary goal of the health service’

Section 10.2 ‘Managers can speak with particular authority about... whether the health service is achieving its purpose’

This is but one example of absolute confusion. The report contains several others. Of particular note is the proposition that managers (no doubt because of their ‘particular authority’) ‘own the outcomes’ of decision-making in the NHS, ‘set agendas’, and ‘are required’ to ensure that decisions are ‘in keeping with agreed values’. In addition, managers have ‘to be non-partisan guardians of the (decision-making) process in order to safeguard the public interest’.

But even the most pressured football manager would be able to rise above the melée for long enough to grasp that it is simply not possible to ‘own outcomes’, ‘use agreed values’ and ‘set agendas’ (thus specifying the ‘public interest’) without being partisan.

It is embarrassing to point out such intellectual poverty. And distressing to know this is the standard of thinking of many of the people now in charge of the health service. We, the public, are not the Board of Directors of the NHS. We have no power whatsoever to change this dreadful state of affairs. We cannot sack managers however often they write nonsense, or however much they deserve it.

Managers are getting away with it. They have imported a mumbo-jumbo management-speak from the world of commerce. In their pseudo-science it can be said that ‘health-gains’ are continually being made, even though they cannot be defined. ‘Values embrace concepts’, promoting health is ‘essentially proactive’, ‘quality’ is everywhere even though things are palpably getting worse - the emperor is obviously naked, yet no-one dare tell him.

The team I supported is wearing a new strip, my protests fall on deaf ears, the NHS seems certain to be relegated under present management - and I, for one, am sick as a parrot.