Orwell, who explained that to change thinking you first have to change the language, would have recognised how management is implementing the latest fad.
Meetings are peppered with ‘service line management‘, ‘stragetic business units’ (SBUs), ‘profitability’ and ‘re-engineering‘. Service line management is the latest solution to everything, heavily endorsed across the NHS by Monitor, so I guess some of you out there have also have been divided in SBU’s and are enjoying the amazing benefits thereof.
While it might be the best thing since ‘lean’ if you’re, say, a cardiac surgeon belonging to a neatly-defined team, for the anaesthetists or radiologists amongst us who provide services in many areas, it’s not quite so positive. We now find our departments deconstructed and parcelled out amongst other business units.
Nevertheless, we are repeatedly told that devolving management responsibility to front-line staff leads to ‘increased staff engagement’ and ‘improved morale’. Not only that, but it also – and I really think there must be some sort of magic power at work here – improves patient safety and outcomes.
Senior managers have been heard to claim that there are people walking around out there who “wouldn’t be here” if it weren’t for service line management. Perhaps they should check the bottom of the garden for fairies, while they’re out and about…I’m afraid I need to hear the mantra a few more times before I’m ready to get on board.
While the NHS is happily occupied with deckchair rearrangements, similar techniques of persuasion are being used at much more elevated levels. Statements which are extremely dubious and, in some cases, clearly contradicted by evidence, become widely accepted and eventually pass unchallenged. A couple of oft-heard examples spring to mind:
1. The NHS is NOT being privatised. And
2. Public sector pensions are an unaffordable burden on the taxpayer.
It works like this – firstly, wheel out a senior minister to repeat the ‘fact’ in a simple soundbite, ridiculing anyone who disagrees. Secondly, blame any problems on a) the last government, b) the public sector or c) Europe. Third, ensure that the media trots out the party line. Lastly, repeat several times a day for at least six months. Result – fiction becomes fact.
The problem lies, I think, in that people naturally want to believe everything’s OK, and health economics is very complicated. Real explanations don’t lend themselves to soundbites or doorstep conversations. How do you convince people that the NHS is being, effectively, privatised when they don’t understand how the NHS works now, and privatisation to them means having to take their cheque book to Casualty. You’ve lost them after the first mention of clinical commissioning groups.
Similarly with pensions, anyone listening to the news would think private sector taxpayers donate their entire wage to our gold-plated pensions while we sit about booking our next holiday in Tuscany. Again, the smokescreen relies on the fact that hardly anyone understands pensions. Unless you’re going to sit down and read about Funded and Unfunded pension schemes and accrual rates (yawn) you’re probably going to simply believe whichever set of politicians happens to have grabbed the mic. In fact taxpayers (other than ourselves) are NOT funding NHS pensions, nor are they projected to do so.
The first rule of politics – which is what hospital management is morphing into – is that if you say the same thing often enough for long enough, no matter how wacky or evidence-lite, you will eventually be believed. Let’s not be brainwashed.