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'Management's not actually a bad idea when you think about it'

Management. The word conjures up all sorts of images for nurses.

Probably - in most cases - not very positive ones at that. We talk about clinicians working “on the shop floor” or “at the coalface”, even “in the [battle] field”. By implication, managers sit in cosy offices, far from the fray, or worse, act like the ruthless taskmasters employed by the old mine owners or generals and their staff enjoying afternoon tea while their troops were slaughtered in the trenches.

Giving managers a bum rap is easy, especially when they came up through the ranks and seem to have forgotten what it’s like to be “one of us”. Yet, sure as eggs is eggs, the vast majority want to manage well. If they’re not - or are perceived as such - it is something to think about rather than condemn.

Local managers have a highly complex task in what is, definitively, a public service being systemically [mis]managed within a business model that takes no account of the lack of business principles e.g. matching supply to demand, providing incentives, borrowing to invest in new developments etc. Most particularly, the business model can’t accommodate clinicians committed to a non-business approach to health care.

In fact, managing people and relationships - at all levels of the service - is something few managers are schooled in. The ability to do this well defines the popular and effective manager. And the simple truth is that effective management is at the heart of good healthcare.

The problems are exacerbated in the NHS by its highly political nature. Civil servants need to deliver for Ministers. Bullying has been an increasing response to this in the past 20 years, passed down from our political masters into the service itself. Top-down targets are devised and, in many cases, subtly ignored or can’t be met. Demand can’t be met. The response is service re-organisation. Just as new relationships are being formed, the process starts again.

One consequence is (often unexpressed) conflict between nurses and their managers. This isn’t to say it doesn’t exist elsewhere. Indeed, conflict is the faultline running through the NHS. But managers are frustrated nurses won’t do what’s demanded of them, nurses that managers don’t understand. The chasm widens.

It’s not a recipe for success. Responding to this complex situation, transforming deeply conflictual relationships is the real challenge facing the NHS in 2012. Cuts and the health bill will make it much harder.

Chris Hart

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