COMMENT
John Clark, a senior fellow at the King’s Fund’s Leadership Unit, explores the history of general management versus clinical management in the NHS.
M
any readers will be too young to re- call the Griffiths Report published in
1983, but it provided a “fundamental cri- tique of NHS management and its failure to ensure that resources were used effectively or with the needs of patients in mind. Spe- cifically, the report identified the absence of a clearly defined general management function as the main weaknesses of the NHS” (Spurgeon et al, 2011, p.35).
The Report itself concluded that the ab- sence of this general management sup- port meant that there was no driving force seeking and accepting direct and personal responsibility for developing management plans, securing their implementation and monitoring actual achievement.
This significant analysis led to the appoint-
ment of general managers at all levels to provide leadership and cost improvement and a more dynamic management ap- proach. Interestingly, at this time, the re- sponsibility for managers to lead improve- ments in quality and safety were not ex- plicit functions of this new breed of health service manager.
At the same time, the Griffiths Report argued that hospital doctors should accept the management responsibility which goes with clinical freedom and participate in decisions about priorities. Prior to the Griffiths Report, hospital doctors were grouped into divisions of specialties (Cogwheel Divisions) with a chair elected by their peers for a period of two to four years. There was a tendency for the role to be undertaken reluctantly and to be
given on seniority. There was no additional remuneration and certainly no assessment of leadership competence.
Essentially, the Cogwheel system provided the platform for the subsequent phases of organisational arrangements within hos- pitals and the ways in which doctors were engaged in decision-making.
Following the Griffiths Report (1983), the Resource Management Initiative (1986) led to most hospitals introducing a medical management system based around clinical directorates. Senior doctors were appointed as clinical directors and most were paid an additional session or two for their leader- ship role. Again, most appointments were based on seniority and rarely on the basis of leadership experience or competence.
32 | national health executive Nov/Dec 11
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100