The first three tiers of management in the NHS: the Secretary of State, the Ministers and the Parliamentary Under-Secretaries are all politicians. As politicians their careers have been spent honing their media skills and their public speaking. Few politicians have any experience of managing significant numbers of staff. The current Secretary of State for Health, Alan Johnson, entered politics after a career in the unions. He doesn't have any experience managing large organisations to prepare him for the challenge of managing the 1.3 million staff in the NHS.
Equally, they only have a limited knowledge of the healthcare sector. Alan Johnson worked in the postal union but is placed at the top of the NHS chain of command. While he will have plenty of advisors and civil servants, some of whom may have experience of the sector, he will find it impossible to properly understand their advice or choose between conflicting advice, without experience in healthcare to guide him.
Inexperience at the top is matched by poor management practices further down the organisation. There were first problems with organisational stability at the Maidstone & Tunbridge Wells NHS Trust, at the centre of the recent controversy over hospital infections, the Healthcare Commission said:
"The lack of organisational stability with numerous structural changes over the last three to four years, meant managers could not settle into roles and focus on the key issues. The high turnover of executive directors and senior managers caused instability and left gaps in leadership as the trust grappled with its very busy agenda. Many staff felt the degree of change had been damaging and had contributed to the lack of clarity on accountability."
The figure at the centre of the problems in Maidstone & Tunbridge Wells NHS Trust is Rose Gibb. She was the Chief Executive of the Trust, an organisation with a budget of £243 million and 4,527 staff and she was paid between £140,000 and £150,000 per year. The Commission described an autocratic senior management that failed to build managerial and leadership capacity throughout the organisation. There was little delegation. This failure, built on a failure to properly give responsibility to junior staff, is the hallmark of leaders who are uncomfortable in a management position so try to do everything themselves.
Also, Mrs. Gibb is described as difficult to challenge. All it would have taken is one effective challenge to her repeated assurances that the infection problem was being controlled for the Trust to accept that it had a major problem, after that it could start to do something about it. Lives could definitely have been saved.
Management in the NHS needs to be improved if we are to avoid more tragedies like the one the Healthcare Commission has just uncovered.