Journal Column – The Buck Stops Here

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We Can’t Fix Public Services If the Managers are Not Accountable.

The NHS has very much been in the forefront of our lives recently and last year many of us clapped to show our support and appreciation.


Like many, I have witnessed the NHS at its best as members of my family and friends have received first class treatment and care, without which outcomes would have been very different. 


However, it would be naïve to think the NHS is still the “envy of the world”.  Indeed, according to a 2021 report by the World Health Organisation the UK is now in 18th place in the healthcare league behind Portugal, Italy, Greece and Spain. Why is it, that with such a massive budget and so many people working in the health service, standards appear to be dropping?


It seems a day can’t go by without another media story about filthy conditions, neglect, maltreatment, botched operations, wasted resources and equipment shortages. The tragic 52 baby deaths at the Telford and Shrewsbury hospital maternity department and the 1,200 patients that died in filthy, bug infected, wards in the Mid Staffordshire hospital being two of the worst cases in recent years.  


I personally don’t believe that the NHS is short of money or resources and so will not accept that argument as an explanation as to why we have slipped so far down the world healthcare league and seeing increasing cases of maltreatment, abuse and uncaring treatment of patients, in particular the elderly. I believe the answer lies in the vast scale and extent of the modern NHS.  It has become so big and all-encompassing that its sheer size, administration and overly complex bureaucracy is preventing it from functioning as effectively and efficiently as it could. 


It’s not just that there are just too many administrators and meddling managers, It’s my view that too many are ineffective, utterly complacent and, for many, seemingly unaccountable.


Richard Branson once said “…Let’s get right down to the point: good people are not crucial to a business, they are the business…Finding them, managing them, inspiring them and then holding on to them is one of the most important challenges a business leader faces and your success, or lack thereof, plays vital role in the long term-term growth of your business…”


Granted, the NHS is not an airline, railway or bank, but the same principles of leadership and responsibility lie with big public sector organisations, such as the NHS, as it does with big commercial enterprises such as energy or telecommunications.


Senior managers in the NHS benefit from very generous remuneration packages. There’s nothing intrinsically wrong in offering senior people, in charge of large organisations, a reasonable remuneration package.  The key though, is that in return for handsome pay and perks, these senior managers need to be fully accountable and responsible for the organisations they are paid to run. Otherwise, what’s the point of appointing them?


While it is true that much of the poor care and hygiene in relation to the Mid Staffordshire fiasco was at the hands of staff at ward level, that does not mean the trust managers can be excused.  Far from it. It is the role of managers to oversee the activity of their staff.  If the ward staff are not performing up to standard then they are ‘managed’.   Managers have a range of tools and processes in place to ensure personnel, under their charge, are working properly and to an acceptable standard.   Simple, uncomplicated things like appraisals, performance monitoring and inspections. If some individuals are performing below standard then, depending upon the circumstances, there are a number of remedial options available, such as additional training, job re-assessment and of course disciplinary action.


It’s not on to claim that just because a NHS Trust is a big organisation and individual trust managers are far removed from the day-to-day operations of the hospitals they somehow cannot held accountable. Sorry, but that’s what being a boss is all about; it’s what bosses are paid to do. If managers don’t know what’s going on or fail to put into place a robust system of managerial oversight, then that’s their look out.


It’s like that in the private sector, so why should the public be any different?


BP, for example, is a big multifaceted organisation and I’m sure their former CEO, Tony Hayward, was far removed from the oil rig that sprung a leak off the coast of New Orleans in 2010, but that didn’t stop him being held responsible though did it? It didn’t stop him being called to answer for his organisations blunders to the US Congress. Hayward eventually resigned because he knew that with the top job he ultimately took responsibility.


If the owner of a private care home can be prosecuted for corporate manslaughter and sentenced to three years in prison after a resident in their care home died from poor care, then why can’t the trust managers of the Mid Staffordshire and the Telford and Shrewsbury hospitals?  


We can’t have one rule for the private sector and one for the public, since it will lead to division and conflict.  If senior managers in the public sector wish to demand similar pay and conditions as their private sector counterparts, then they need to accept that when things go wrong they can’t ‘pass the buck’, because, as former US President, Harry S Truman said of the Presidency “The Buck Stops Here”.


This column was published in the Newcastle Journal on the 1st July 2021.