Headlines: December 14th, 2006



Chronically poor management and dysfunctional bureaucracy are hindering the performance of the National Health Service, according to a new report today. It claims that a lack of a vision of change and poor quality of management in the NHS and the Department of Health are leading to resources being wasted and reforms being delayed. It argues that moves towards a higher quality service, offering better value for money, depend directly on a transformation in the quality of its management.

The paper comes from the independent think tank Reform and has been written by Ian Smith, a leading private sector manager who was one of the two final candidates for the job of NHS Chief Executive. In “Building a World-class NHS”, he argues that a well managed change programme based on patient value can deliver dramatic improvements for patients and the taxpayer.

Smith identifies three key factors for the service to succeed – provision of sufficient resources, appropriate reform policies and effective management. The Government, he says, has made considerable progress on the first two but the problem of a ‘centralised, dysfunctional bureaucracy with its chronically poor management’ has not been addressed. He warns that unless there is urgent action, poor management will undermine the funding and policy achievements. He believes NHS management fails because of the quality of managers themselves and the absence of a coherent vision of change. “Ministers and their advisers have a hugely impressive commitment to reform but have little management experience and yet still take management decisions. Senior managers in the Department and in NHS organisations are profoundly conservative and risk-averse,” he writes.

The study’s main findings include dysfunctional organisation and poor management at all levels, up to Ministers themselves and the lack of a coherent change programme in one of the largest change processes in the world. That, he says, leaves clinicians at all levels prevented from using their expertise to improve patient care and feeling deliberately excluded from management although they are responsible for 75 per cent of healthcare spending. The core of a coherent change programme, he argues, should be a vision of where the process is heading. Once that vision has been defined and clinicians are signed up to it, the programme can be put in place and it should include decentralisation and removal of bureaucracy and politics from the system, stronger demand-side mechanisms and the recruitment of managers with experience of managing large change projects.

Ian Smith believes the mark of success will be senior Department of Health and NHS managers becoming obsolete, leaving a healthcare economy in which local decision-makers work day by day to maximise patient value.