Managers can only do their jobs within the rules of the game. The rules say they are not allowed to mention that all health care is rationed, that technology and new drugs cost more than we can afford, and that consultants are afraid to speak out and ask the right questions in a “culture of fear”. Critical Incidents are legion, and there are so many that juniors and their consultants have given up reporting the less significant ones, like unavailable notes are a common problem. Many are very personable, but without the tools, and honesty they cannot gain the trust of their staff. Compounding this, in Wales, is the lack of sufficient funding owing to the Welsh Synod. If we had no assembly we could have 10% more on health and education in Wales. The autumn elections here in Wales will be interesting, and the vote for the “Abolish the Welsh Assembly” party may rise significantly. No wonder there is invective thrown at managers, usually in private, because they are not allowed to speak the truth about what we cannot have. Managers should be able to change the rules, and “win”, but such an outcome is impossible in a service where there is a pretence of “Everything for everyone for ever for free”.
The rules mean that there are perverse behaviours leading to perverse outcomes. Enoch Powell was right, and the managers know it:
A professional body able to hold Welsh NHS managers to account and strike them off for poor performance should be set up, a Plaid Cymru AM has said.
Helen Mary Jones has called for more scrutiny to prevent a repeat of the Cwm Taf maternity scandal.
A damning report earlier this year said the department was “dysfunctional” and mothers had “distressing experiences”.
But Health Minister Vaughan Gething told a debate such a new body could be complex.
Ms Jones said scandals at Cwm Taf, Tawel Fan mental health ward in Ysbyty Glan Clwyd and elsewhere “exposed consistent and systematic management failures across our Welsh NHS”.
Professional regulatory bodies already exist for doctors and nurses, but Ms Jones want a similar professional body for managers.
The Plaid health spokeswoman said senior staff should be registered, so they cannot fail in one local health board and get a job at another.
But unless it is taken on by ministers, Plaid’s proposals are not expected to reach the statute book.
The Welsh Government has its own new law planned to place a “duty of candour” on NHS organisations, requiring them to be open and honest when things go wrong.
Plaid Cymru wants ministers to go further, putting a “legal duty of candour” on health professionals to “empower” whistle-blowers.
Jon Restell, chief executive of trade union Mangers in Partnership, said: “This kind of rhetoric damages morale and effectiveness of management and has a chilling effect on recruitment to these posts, especially clinicians.”
He said he would “welcome any investment in professional standards and development for NHS managers”, but any regulatory process “would need to be fully independent of the political process”.
Ms Jones called for new legislation in a debate on Wednesday – with support from the Conservatives and Brexit Party.
Mr Gething did not support the idea of a new regulatory body for NHS managers, saying it “would introduce a level of cost and complexity, but of course that’s always the case when introducing new measures”.
One consideration, he said, would be defining “who or what a manager is to be called within the ambit of a new regulatory body”.
Cwm Taf’s maternity services were put into special measures after failings were uncovered at the Royal Glamorgan and Prince Charles hospitals, prompted by concerns about the deaths of a number of babies.
The Welsh Government said it wanted to “create a culture of continual learning and improvement in our NHS”, adding: “We have already introduced our Quality and Engagement Bill which will increase openness and transparency across the NHS and give a stronger voice to staff and patients.”
The government’s bill also proposes to replace Community Health Councils with a new body – there have been concerns about a lack of detail on what will replace
NHS middle managers too comfortable to take top jobs “Kafkaesque regulation and rising patient expectations mean that managers and doctors opt for an easier life in less demanding roles”… political courage is needed.
Patients and the professions are ready to ration health care strategically, without devolution. It’s the politicians and the managers who won’t hear of it because the strategy might mention rationing.
What sort of evidence do Trust Boards and CCGs listen to? The Single Interest Pressure Group and levels of evidence. Do Commissioners and Trusts have policies to cope with them? Case studies are not valid evidence.