Feature

Burnley Trust: just about managing?

Recent events in Burnley NHS Trust sound like another tale of ‘macho management’ running amok. But it’s hard to spot the good guys in this particular story, says Alan Walters

American-style management is having problems establishing itself in the NHS. Somehow it does not seem to work with our bumbling bureaucracy, which has a knack of combining crucial errors of judgement with an amateurish ruthlessness. The current crisis around gynaecologist Ian Mahady and Burnley NHS Trust is a good example of this ineptitude.

Legend has it that Mahady was summoned before local bureaucrats whilst the chief executive was on holiday, offered a redundancy package and promptly sacked when he refused it. The sacking was outwardly tough because he was given three hours to clear off, but inwardly tender because he was not expected to work out three month’s notice.

Protests about the interruption to patient care, with a post-operative ward full of patients and fully booked outpatient clinics scheduled as normal, were dismissed, with management having made alternative plans to deal with the clinical fall-out.

The consequences were predictable. Protests by the hospital consultants over such behaviour were complemented by adverse press publicity, the intervention of heavyweights like the BMA and the local MP, and a crop of petitions and pickets from local citizens. The chief executive walked into the flak on her return from holiday, and the medical director of the trust, Dr Sam Pickens, found his colleagues more than somewhat critical of his role in the affair. Both have now, of course, resigned.

The outcome of the immediate conflict was an internal enquiry, with the sacked consultant now simply suspended on full pay pending an appeal to the secretary of state. The political temperature of the whole escapade fell as the issues were transferred from the public arena to the less visible world of the enquiry, but this had little impact on the hospital’s collective mood, which remains shaken and volatile.

The protests about Ian Mahady, and the retreat of local management, have obscured the origins of the conflict. The mythology of the dismissal, the silence that surrounds the investigation, and the emergence of a smear campaign to discredit Mahady through criticism his personal life, now make it difficult to know why he was dismissed at all.

Rightly or not, Mahady was blamed for a reduction in admissions to the maternity unit at Burnley, and for a knock-on effect on the neonatal unit, which may not remain viable if the birth rate in the hospital continued to drop. His negative effect on use of the maternity service was attributed to his unsympathetic style, a bedside manner deficit not unknown amongst surgeons generally.

Worse, he was seen as the defiant ringleader of a group of gynaecologists who resisted managerial efforts to increase their productivity. The appointment of two extra consultants and creation of a new facility diverting all terminations of pregnancy away from gynaecology operating lists did not result in the expected increase in patient throughput, and the contract with the local purchasing authority was not fulfilled.

This did not seem to reflect a desire on Mahady’s part to siphon off patients for private practice, as many gynaecologists do elsewhere, because he is reputed to be uninterested and only marginally involved in private work. His critics explain this disinterest as an inevitable consequence of his brusque style — too few would be willing to pay, they say — but this may be wide of the mark.

Given these negative attributes, it is no surprise that he became a target for an increasingly cost-conscious management. But the management itself was not without problems. Chief executive Margaret Aikman had risen from the finance department, where she had been effective but had never developed the necessary person management skills, and had made so many enemies amongst clinicians through a combination of her aggressive style and limited understanding of their work that the name ‘Maggie’ fitted well.

Consultants who hold no brief for Mahady wanted her cut down to size, and indeed have had their way, for she resigned at the end of October. (Note to NHS managers: the days of a chief executive who creates a political fuss just before the Conservative Party conference are numbered.)

Similarly, the medical director was widely disliked for being openly critical of many of his colleagues, who did not like their efforts to maintain quality services dismissed by someone they saw as semi-detached from real medicine. A vote of no confidence by the consultant committee merely goaded him to refuse to resign, and the trust board fuelled the conflict by expressing its confidence in him. A meeting between the board and the consultant staff revealed that the non-executive members had little idea of what was going on, and that the chairman, a genial Tory placeman, was not in control of either the situation or the organisation. Eventually, repeated votes of no confidence by the consultants brought about the inevitable resignation.

All along, the favoured option appears to have been the loss of both Ian Mahady and chief executive Maggie, with later replacement of the medical director and the trust chairperson once the main trade-off had occurred. The worthies on the trust board are having to catch up fast with the details of a political intrigue that is not so much Byzantine as Ruritanian. The unsuspecting public is encouraged to carry on marching, as if the political issues divided neatly into good doctors against a wicked management, and all the while the purchasers are plotting where to put their contracts. It’s almost medieval.