Letter

Look back and learn

Dear healthmatters – As one now retired from the rough and tumble of NHS life, I offer my thoughts on the present ‘consultant contract crisis’ with some hesitation.

Sadly, constructive dialogue between professionals and politicos appears to have come to a grinding halt. The ‘take it or leave it’ attitude reflects the loss of trust that set in over a decade ago with the final act of ‘managerialisation’ of the NHS hospital service which marked the internal market reforms. The imposition of tough new hospital management regimes, working to inflexible new financial imperatives and operated by ambitious, competitive commercial executives deliberately set out to show hospital consultants who was boss and the essence of that regime is with us still.

In the 5 years (1985–90) leading up to those reforms a small number of UK hospitals took part in the Resource Management Initiative, an agreed innovatory pilot study of true clinical management and the use of modern information technology in NHS hospitals. Semi-autonomous clinical directorates were formed to run the institutions, each acquiring its own operating budgets and professional managers from ‘the centre’ and responding to a management board made up of clinical directors, senior nurses and ancillaries, finance officer and so on and headed by a respected clinician. Working within a broad remit of responsible clinical self-regulation the novel structure rapidly evolved its own rules and systems and within a couple of years was beginning to work well and to suggest more universal application.

Of course all of this was grafted onto a chronically and seriously underfunded service. Some accused us of being Thatcher cats-paws in trying to make it work better. In any case, something quite different was being planned ‘behind the scenes’. Many of us regarded the eradication of this clinical management by the new apparatus of chief executive and management board in a competitive new hospital market ethos as a great betrayal from which the consultant body has not yet recovered. The present negotiatory hesitations owe much to this loss of trust. Perhaps the Department of Health should dust down the reports and experiences of the RMI and pick up where it left off to help restore confidence and trust.