Leadership in the NHS, especially at the hospital level, is problematic.
The generally poor quality of management has been mentioned, and so, too, the fact that they are woefully under-supported and under-resourced.
This failure of management can result in clinician disengagement. Clinicians still look after their patients, but sometimes they focus just on the patient in front of them, and do not get fully involved in the broader management task, having been let down, as they see it, so often and so badly in the past.
For example, surgeons no longer manage their operating lists.
This is now undertaken by a ‘theatre list management team’, divorced from the patients resulting in theatre utilisation far inferior to that achieved in the private sector and incapable of resolving the ‘waiting list crisis’.
It leads to disengagement of the surgeons who – if given the authority and the re-instatement of the ability to manage their clinical team – would significantly increase both the efficiency and the safety of the NHS.
Decisive, competent leadership, both clinician and managerial and with clear executive authority, is a prerequisite to achieving the reforms we need.
Supporting management and developing them, on the one hand, and re-engaging clinicians on the other is a key element of the turnaround of the health and care system.
More clinicians need to be induced into management, and non-clinician managers need to be better educated and better induced into the clinician perspective.
There are incipient health management courses at some UK universities, such as Imperial and Warwick, but Corporate NHS has to invest with them and support them in developing ‘Medical MBAs’.
These MBAs would teach advanced techniques in management, techniques that are sorely lacking in an NHS management clique that has been hermetically sealed off from the private sector, where competition has stimulated innovation and efficiency.
The MBA, and its sub-modules for shorter duration courses, would be aimed at clinicians who want to make the transition to managerial roles, and to non-clinician managers who want to deepen and broaden their skill set.
Core elements of the Medical MBA would comprise a ‘general management’ content, but would also include the effective management of the key processes within hospitals and the broader healthcare economy.