By jingo! We have the managers

Observations on the NHS

The organisation that the National Health Service most resembles is the Bolivian navy. That formidable force has no ships and no outlet to the sea, but it has many admirals with splendid titles and uniforms. Doubtless they all become management consultants to the navy when they retire.

It was the annual report of the NHS trust for which I work that brought this analogy to mind. The report is glossy, expensively produced and colourful, with pictures of smiling workers and patients. Indeed, one young man appears as a staff member in one picture and as a patient in another, 14 pages on. Perhaps working for the trust made him ill.

Yet there are signs that not everyone at the trust is entirely happy. The report says that the results of a staff attitude survey were "very encouraging", with 52 per cent giving "a very positive response". Unfortunately, however, only 22 per cent of the staff took part in the survey, which means that approximately 11 per cent replied "very positively". Even Tony Blair does better than that in general elections.

Nor can all the managers be entirely happy with the working of the trust, though it is for their benefit principally that it exists. Seven per cent of the staff are doctors, according to the report, while nearly 20 per cent are managers: that is to say, our trust employs 265 doctors and 756 managers. Yet not even all the managers can have expressed satisfaction, given that only 442 positive responses to the survey were received in all.

The trust board, which has as many members as the average British cabinet during my youth (though they sound much more important, having titles such as "Director of Strategic Development"), declares its private interests at the end of the report. Five of them own, or have relatives who own, consultancies whose business is to advise the NHS how to run itself. This is what passes for private enterprise in modern Britain - a perpetual feeding at the trough.

This report on the Emile Coue world - in which every day, in every way, everything is getting better and better - does not mention the trust's permanent bed crisis. Because of the crisis, a single admission can cause shudders throughout the system.

Here is an example of the dialectic: the more managers there are, the less there is to manage, and the less there is to manage, the more managers there are. Nor does the report mention the forthcoming closure of a hospital built just 14 years ago, no doubt an example of what is now known in NHS circles as strategic development.

This article first appeared in the 27 September 2004 issue of the New Statesman, The real Tony Blair