Readers have responded to Tom Dolphin's article on the failings of NHS management, with one arguing that most public services are over-managed and another highlighting the importance of whistleblowing policies.
Over-Management and the Thatcher Legacy
Pete Dorey from Bath believes that most public services are thoroughly over-managed, with frontline professionals neither listened to nor respected by their institutional superiors. He says these professionals risk damaging their careers if they speak out about poor decisions, excessive workloads, or impossible targets and 'performance indicators'.
Dorey traces the rise of managerialism back to the public service reforms of the Thatcher governments in the 1980s and the mantra of 'management's right to manage'. He notes that as professionals were supposedly self-serving vested interests, the transfer of power to managers was supposed to increase efficiency and responsiveness to service users.
However, he argues that in many cases, the long-term result has been the rise of excessive, remote, and unlistening senior management, alongside the marginalisation or exclusion of professionals from decision-making in their spheres of expertise, coupled with plummeting morale.
Whistleblowing and Board Responsibility
Michael Barrett from London says that hospital board members do have responsibility for their overall management, but how well they exercise their responsibilities depends very much on leadership and the creation of a culture committed to patient care and excellence throughout all systems delivering that care.
He states that one of the essential assurance measures, along with risk management and clinical governance, is the promotion of a whistleblowing policy that encourages reporting of concerns to board level without fear of repercussions and with certainty that action will be taken if necessary. Barrett adds that any hospital management teams without a clear protocol for raising and pursuing problems, confidentially if appropriate, should be a matter for urgent action.
Lessons Not Learned and a Personal Tribute
Frances Kirkham from Birmingham responds to Yvette Cooper's statement that 'This must be a turning point for the NHS', noting that the cry always goes up that 'Lessons must be learned'. She argues that carefully considered, evidence-based recommendations made by public inquiries or coroners are invariably ignored, with reports placed on a high shelf in government to gather dust.
Jenny Webb from Chichester, West Sussex, offers a personal perspective, recalling the death of her daughter in the intensive treatment unit at Leeds General Infirmary. She describes the service as wonderful, not just in medical expertise but in the kindness and loving consideration of all staff, from consultant to ward clerk. She says they were always kept fully informed and were consulted on the final decision to turn off life support.
Webb concludes that while it is right to criticise the NHS for its shortcomings, its strengths and potential to help people through difficult times should also be treasured.
