In 2003, the Centre for Policy Studies published Harriet Sergeant's report, 'Managing not to Manage: Management in the NHS,' containing many of the points made by the Francis Inquiry in the wake of the failings at Stafford Hospital. Harriet Sergeant writes for the Daily Mail on Wednesday 6th February 2013.
To view the full article, please visit the Daily Mail website
"The remark was made only in passing, but it summed up the problem that has blighted our National Health Service for far too long.
I was standing next to a porter in an NHS hospital corridor. Ahead of us clustered a group of men and women in suits, sipping coffee. I had never seen them on the wards. Who were they? ‘Managers!’ the porter snorted. ‘The only time you see them is when they are hovering around the coffee shop. They never go on the wards. All they do is get in my way when I push a patient through.’
I thought of his words this week when Julie Bailey, co-founder of the lobby group Cure the NHS, described the horrors she had witnessed on the wards of Mid Staffordshire Foundation Trust. ‘You only had to open a ward door at the hospital . . . to know that care was appalling. But the people in charge chose not to do that.’
Nor was it just managers who failed to take that simple step of opening the ward doors. It goes all the way to the top.
Yesterday Robert Francis QC published his second report into the failures at Mid Staffordshire, laying bare how a wide range of commissioning, supervisory and regulatory bodies in the NHS — right up to the most senior figures at the Department of Health at Whitehall — also failed to see for themselves just how their policies were playing out on NHS wards."
To view the full article, please visit the Daily Mail website
Harriet Sergeant's report, 'Managing not to Manage: Management in the NHS', can be found here.
Below are each of the points the Fisher Inquiry identified and what Harriet Sergeant had to say in 2003:
Poor governance –
“NHS management lack the basic tools of management. They cannot reward the excellent. Nor can they sack the incompetent (or not without great difficulty). Instead miscreants are promoted, reemployed in another job (chief executives tend to go to the Department of Health, nurses into out-patient care, and porters to catering) or, at the most, reprimanded ‘in a soft voice’ as one former matron described and ‘offered a training course’”
Professional disengagement –
“The disconnection is there for all to see. In most hospitals it is a physical fact. Management nearly always work in a separate wing or building to the hospital segregated by a lawn, a tennis court or, in one case, a Japanese garden. They are tranquil, often attractive places that have little in common with the hospitals they serve.”
Wrong priorites –
“The problems of NHS management are exacerbated by what the NHS Confederation has called the ‘disconnected hierarchy’ of NHS management. The NHS Confederation has stated that the top of the organisation ‘is not effectively connected to the front line and may not even share the same objectives and priorities.’”
Patients not heard -
“The arbitrary nature of care in the NHS falls hardest on those people least able to stand up for themselves. The NHS has generated many myths but the myth that we all receive equal service is the most pernicious. In a poorly managed hospital, it is a free for all. The meek and the ignorant are made to wait, get overlooked and receive, as I saw, bad and often life threatening treatment. The well connected, the middle class and the obstreperous jump the queue.”
Lack of focus on standards and service -
“Again and again, chief executives told me their first priority was to appoint a new manager to ensure they were complying with the latest government initiative. The management board meeting I attended was almost wholly taken up with discussing compliance. The Government has created a Kafkaesque situation. Hospitals are recruiting more and more managers to monitor care which fails to improve partly because of their appointment.”
“The NHS Plan calls for patient-centred care. This is a wake up call to NHS management. One they will take time to assimilate. Management are not used to thinking of the NHS as a patient service. Until now ‘the bulk of managerial attention,’ has been, as Just Managing: power and culture in the NHS put it, ‘devoted to other groups of employees rather than towards patients.’”
Negative culture -
“A PORTER IN THE WEST COUNTRY had this to say on his hospital’s middle management. ‘We have 20 to 30 managers. Half of them don’t know what they are doing. They hang around the coffee shop and get in my way when I am trying to push a patient through.’ One of his patients, an entrepreneur, raised his head to stare, ‘If I had that many managers,’ he remarked to the porter, ‘My company would be bankrupt.’”
Inadequate risk assessment of staff reduction -
“But that is exactly what is happening in the NHS. In a world of limited resources, hospitals cannot afford seven clinical auditors, however ‘friendly and helpful,’ and seven nurses. It is one or the other. The Government has created the bizarre situation where hospitals take on managers to check and evaluate a service that is deteriorating because of their appointment. Which would the patient prefer? A hospital compliant with every government initiative? Or their ward staffed by a full quota of nurses? And would a hospital without staff shortages need so much monitoring?”
Nursing standards and performance -
“The patient exists in a power vacuum. Who is in charge of my health? Who is responsible and accountable for what? These are the questions any patient in a badly managed hospital will ask with increasing panic… No one person appears to have the authority to oversee all the elements of a patient’s care, pull them together and take responsibility for that person’s well-being. Whether you enjoy attentive nurses, a proper diet and clean wards is pot luck. As one patient remarked, ‘After my last operation for a mastectomy I had no nursing. There was only one nurse on the ward. I could barely get to the lavatory on my own. My daughter had to bring in food, help me wash and comb my hair. The nurses never brushed my teeth once. This time I have been well taken care of.’”