However you choose to look at it, NHS management is going through something of a crisis. Credibility, reputation and overall purpose are all under scrutiny and at risk. Arguably, the nursing profession is not too far behind with its own particular challenges.

‘The NHS can’t divorce itself from societal attitudes and behaviour because this is the pool from which staff are recruited’

What we see is both professions linked by a series of events from the Francis report to whistleblowing to demands for more compassion and culture change, which are coalescing to potentially bring about a near-perfect storm for confidence, trust and leadership.

What is self-evident is that the current restructuring will solve none of these issues and will remain an unnecessary distraction until it settles down. Furthermore, the overwhelming majority of managers and clinical staff do a good job, often over and above their contractual requirements.

During my time in the NHS, I did come across a small number of people who were not very good at their jobs (all organisations have them) but to the best of my knowledge I never met anyone who started the day deliberately thinking they were going to do harm or disrupt the system.

Care and compassion

There are two cornerstones for building the future. The first is addressing care and compassion, but the NHS cannot address this in isolation from society as a whole. Numerous surveys have shown British people are less caring and more selfish.

A Red Cross survey in 1999 concluded: “Selfishness was the main reason given for the lack of concern for others. Nearly half of those who felt Britain was less caring cited it as the root cause.” While a Barrett Values Centre report, published only last month, found a major disconnect between what matters most to people and how they feel British society is currently operating, saying:

“People living in the UK want a more caring and compassionate society, with greater accountability and honesty and more effective governance… The report shows that people living in the UK value meaningful, close relationships and operate with a strong sense of integrity. The top personal values selected include caring, family, honesty, humour and fun, friendship, fairness and compassion, as well as independence, respect and trust.”

‘There’s a need to pause and take stock of the purpose, role, organisation and future development of NHS management’

The point here is that the NHS cannot divorce itself from societal attitudes and behaviour because this is the pool from which staff are recruited. Since governments create the societies they deserve then instilling more care and compassion into healthcare is as much a challenge for government as it is for professional leadership.

Future gazing

The second challenge is addressing what may be a disconnect between NHS management and the clinical professions. The question here is whether a gap is emerging because of the traditional hierarchical organisation of NHS management versus the increasingly flat, multidisciplinary and collaboration-based approach to the delivery of medical care?

If so, then perhaps there’s the need to pause and take stock of the purpose, role, organisation and future development of NHS management.

One thing is probably clear when future gazing and it’s this: continuing to organise and deliver the NHS on traditional hierarchical lines is likely to be unsustainable and eventually will be seen as increasingly anachronistic. If there is to be a culture change then it should also embrace structural issues because it’s far from certain that embedding it within the current structure will deliver what is required.

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