It’s back to the future once more, as recently-installed Health Secretary Sajid Javid succumbed to pressures from the Daily Telegraph, which has waged an ignorant campaign bemoaning the numbers of NHS staff who are not “clinically qualified” – and brought in a retired General to conduct a “review” of NHS management.
The ill-founded belief in the powers of ex-military figures and former industrial bosses to “sort out” complex problems in the very different world of the NHS goes back to the mid 1980s, when the Thatcher government began to implement changes in the NHS management structure in line with the 1983 review of NHS management by Sainsbury’s boss Roy Griffiths.
(Griffiths was later also to be the architect of the chaotic 1988 plans to split long term care from the NHS, and subject it to means tested and privatisation that has created the current chronic crisis in social care.)
In the late summer of 1984 the first appointments of district-level Griffiths-style “general managers” (soon to be re-styled – on higher pay – as chief executives) saw only 60% of posts retained by previous administrators, and some going to doctors or senior nurses, but the remainder handed over to (mainly) men and women from business and the armed forces. Most of the non-NHS appointees swiftly vanished without trace.
One of the first military men to take on the challenge was Colonel Peter Davis, who took over as general manager of Nottingham District Authority in early 1985, boasting that he brought a “new pair of eyes to see the wood from the trees and an empty mind to look and listen”. He lasted just 18 months.
Also in and out quickly in South East London were Colonel Tony Hare, after a similarly truncated stint as General Manager in Bexley, and former RAF officer Peter Ward, who stayed even less time at his post in Bromley.
In January 1985, as the NHS scoured the world of Tory businessmen in the quest to recruit a £60,000 per year chair of the new NHS Management Board ministers were warned that:
“people of the calibre required were likely to be either too expensive and possibly too high profile, or affordable but reluctant to leave the private sector for fear of falling behind their peers.”
As a result ministers wound up scraping a less promising barrel composed exclusively of second-raters “the unemployed, those who were not of the calibre required, or those nearing the end of their careers but who had not been successful enough to be out of reach financially.”
They eventually opted for Victor Paige, a previous chair of the Port of London Authority, who admitted he had no Intention of cancelling his BUPA policy. “Like most people l am covered by private medical insurance,” he blurted out. The director of personnel post went eventually to retired IBM executive Len Peach, who had almost no industrial relations experience. Neither lasted long.
In the autumn of 1989 Sir Derek Boorman, former Director of Military Operations in the Falklands War was appointed as chair of Camberwell District Health Authority, moving on in 1994 to chair the Royal Hospitals Trust spanning Barts and the London Hospitals, with a mission to close Barts – resulting in January 1995 in a motion of no confidence in him from 86 Barts consultants.
Boorman stayed on, to set up an extremely expensive inquiry into the leaking of a document, during the course which, according to Labour MP Brian Sedgmoor “there was an extraordinary homophobic outburst,” in which Sir Derek made it clear that he regarded being gay as a human weakness.
Also involved with the attempted carve-up of Barts was Admiral Sir William Stavely, described in the Independent obituary as “one of the less approachable admirals,” who “never courted popularity.”
None of the military appointments have worked out well. There has also been a chronic problem in seeking to bring in leadership from big business:
Nor is Sajid Javid’s initiative the first Tory “war on bureaucracy” in the NHS. In 1995 his predecessor Stephen Dorrell tried a similar stunt, which wound up redesignating 4,000 managers as senior nurses, but leaving the system bureaucratised by Thatcher’s “internal market” reforms virtually unchanged.
The Telegraph headlined the latest announcement as “Royal Marines general called in to bring military discipline to NHS management,” claiming that he was “charged with driving up the quality of management and ensuring ‘every penny’ of taxpayers’ money is ‘well spent’.”
The Guardian, however, reported NHS bosses criticising the review as a “slap in the face” after the pandemic, and arguing it is “a deliberate attempt to shift the blame for the health service’s fragility,” quoting one NHS chief stating: “It’s hard not to interpret this as an attack. This will go down really badly, like a vat of cold sick.”
One minor relief is that Gen Sir Gordon Messenger, a former vice-chief of the defence staff, is not being brought in as a manager or a chair of any NHS body, but purely to produce a report.
However the evidence from previous such reports is that they are either absolutely useless and swiftly discarded (as with New Labour’s brief obsession of Professor, later Lord, Darzi’s impractical and unaffordable proposals for “polyclinics”) or really dangerous and the source of damaging changes (such as the 1983 and 1988 Griffiths reports, proposals for an NHS “internal market” by US guru Alain Enthoven, and the 2009 McKinsey report seeking up to £20bn savings from the NHS).
The chances are that the latest review (which will only focus on the NHS, not on the chaos in social care) will worsen the crisis, persuading even more hard-working NHS professionals and managers to seek the earliest possible retirement or change of career.
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