It’s funny how a night’s sleep can alter one’s perspective, but actually my perspective began to change last night as the cold head-analysis of the health White Paper began to be warmed by a heart-response. My thoughts had gone to those many friends I know working in PCTs, and the impact of effectively being told you were superfluous bureaucracy.
All those long years of trying to dance to the Government’s tune through policy changes, create the right environment, monitor progress, hold independent contractors and hospitals accountable for their spend and delivery, build relationships with patients and understanding with social care, top slice 3% of your budget at a moments notice and support front-line staff. None of them are perfect, but many of them highly motivated to improve the care of patients. Many have lived through huge reorganisations before and will philosophically accept that the structure is changing once again. But I think thousands will have felt hurt, let alone fearful for their futures. Doctors emerged as the heros coming to rescue us from the nasty managers who bore the brunt of blame for the areas in which the NHS has under performed.
The reality is that no GP consortium will be able to deliver improved care without good management. No one will be able to plan appropriate services without advice from those with strategic overview. No doctor wants to waste their time on administration, monitoring, enabling infrastructure, performance management, procedural meetings, implementing IT, data collection etc.
Management won’t miss having to produce and re-write endless documents justifying their existence and the endless top-down initiatives that stifled the one before. But there are many good people for whom today is a lot more uncertain than yesterday and without whom we would not have seen many of the improvements in care that have been achieved. The NHS will never be perfect, but it cannot thrive without good management, and they did not receive justice yesterday.