Turning clinicians into state apparatchiks
A survey asking medical staff to rate the coolness of leaders like Hitler was naff – but so is the entire ‘leadership agenda’.
’How cool is Hitler?’ This question was recently put to 3,300 National Health Service employees in a survey issued by the West Midlands Ambulance Service as part of its research project Making Leadership Cool.
Staff were also asked to rate the ‘coolness’ of other leaders from the worlds of politics, commerce and sport, including Richard Branson, Gordon Brown, Winston Churchill and Fabio Capello, and to say whether they thought being gay, funny or black made a leader cool.
The tactless Hitler question has provoked ridicule and anger, yet the real outrage should be reserved for the leadership agenda itself. Through this agenda the government has been able to turn clinicians, effectively, into policy advocates.
The public sector – particularly the NHS – has become obsessed with leadership in recent years, for a number of reasons. In 2000 the government introduced the NHS Plan, a modernisation agenda which promised British people a health service fit for the twenty-first century. But in order to promote and implement this plan properly, the government needed the active support of the NHS workforce, particularly clinicians who over the years had grown bitter about being sidelined by the managers and consultants running the show.
Enter top surgeon Lord Darzi, who was appointed health minister. One of several non-political figures brought into Gordon Brown’s government, Lord Darzi emphasised that he was ‘a doctor not a politician’. He played a key, figurehead role in the rehabilitation of clinicians, while making proposals for improving the NHS that conveniently fitted New Labour’s agenda. By the time Darzi returned to the ranks, clinicians around the country were pretty much in agreement about the future orientation of the NHS. Management still supported and guided the process of reform, but this time from behind the scenes.
In other words, politicians have cynically used clinicians to front NHS reform. They have hoped that by putting responsibilities for reform in the hands of reliable, trusted individuals like health professionals, they will get their policies accepted both by NHS staff and the public. For their part, clinical leaders do now seem happy to support the political agenda, even though the NHS Plan is, rather than being progressive, made up of stultifyingly dull quality standards and assurance processes.
Also, politicians are aware that health professionals, doctors in particular, continue to be highly regarded and trusted by the public. Clinicians are therefore encouraged to take on leadership positions and many willingly do so. For example, doctors can be found fronting public consultations and meetings when unpopular proposals such as hospital mergers, departmental closures or the consolidation of doctors’ surgeries and other services into ‘polyclinics’ need to be ‘sold’ to the public. Occasionally, doctors offer some resistance to government proposals, but this is easily accommodated because it gives the processes a semblance of autonomy and independence.
Another reason many health professionals buy into the leadership agenda is that they have had negative experiences of working with management consultants. These highly paid outsiders are brought in, at huge expense, to tell NHS staff what they already know. The consultants then take the credit for ideas developed by staff themselves, leaving health workers to implement their (own) ideas without getting the kudos or being remunerated for their creativity. Staff can see that it’s better to participate in identifying, developing and using home-grown talent to do the work than to get short-changed in this way.
Staff are supported in these endeavours by the NHS Leadership Council, which exists to provide inspiration and guidance to leaders across the NHS. It was set up following a recommendation in Lord Darzi’s 2008 report High Quality Care for All. He suggested that ‘Greater freedom, enhanced accountability and empowering staff are necessary, but not sufficient, in the pursuit of high-quality care. Making change actually happen takes leadership.’ And aware of the resentment amongst NHS staff towards managerial types, the new breed of leaders were to be constituted, like Lord Darzi himself, as health professionals first, managers second. As the Leadership Council put it: ‘We want the staff who know how best to provide care to be the ones driving our journey towards high quality in every area.’ That is why the council runs courses which seek to introduce new principles and approaches to leadership, clinical management and team development within the NHS.
It is true that we need leaders. But leadership in the absence of ideas, or simply as a means to impose a pre-ordained agenda, isn’t leadership in the true sense at all. That’s why, for all the high-sounding talk about producing a new class of clinicians who can drive NHS reform, this whole process seems hollow and cynical – as well as distinctly ‘uncool’. It will be interesting to see if the new Lib-Con government has any alternative to the bean-counting managerialism of the last administration, but somehow I doubt it.
Bríd Hehir is head of engagement and patient involvement and sessional nurse in the NHS in London. She writes in a personal capacity.
Previously on spiked
Brid Hehir criticised the covert monitoring of NHS staff and the proposal that nurses in England should be university graduates. Dr Michael Fitzpatrick criticised the squalor of contemporary UK healthcare and argued that Darzi’s interim report on the NHS profoundly misunderstood Britain’s ‘health crisis’. He also argued that Tony Blair alienated patients and degraded doctors. Or read more at spiked issue NHS.