I read about Ramon Niekrash, a surgeon at Queen Elizabeth Hospital in Woolwich, who was suspended for raising concerns about patient care: NHS targets and secrecy are hurting patients. He took his case to an employment tribunal and won. I was stuck by the information that, He was suspended on 9 April 2008 for “excessive” letter writing and because two senior managers from the surgical department had complained, in writing, on the same day, about his conduct, attitude and, most worryingly, his clinical competence. He was writing letters about his concerns for patient care. Apart from the personal issues and the patient safety issues something is seriously wrong when a publicly funded organization is determined to keep its problems secret. This fits with the book I read recently Putting Patients Last.

REWORK (in my reading list) has many recommendations that could be applied. I realize that there is a difference in scale between an organization of 10 people and one of 1.5 million but the NHS consists of hospital departments and surgeries where there are 10s of people that in many ways work autonomously, though linked for patient care. So there may be things to learn and apply from small organizations. One piece of advice is “hire managers of 1″, which in the context of the NHS would mean keeping management minimal and local to the department. It seems from the Ramon example that the department is in the service of the ‘higher’ management, whereas the ‘higher’ management should be in the service of the departments. This fits with the mission statement of putting patients first; the clinicians are in the service of the patients and the administrative staff should be in the service of the clinical staff. In particular this is not to imply a hierarchy of power merely a flow of service. REWORK has rough comment on Mission Statements!

The management’s concern for the good of the universal NHS (to steal a recent (mis)quote from somewhere else) is clearly more to do with self protection than public protection. By this I do not mean to blame individual managers anymore than one can blame any creature that finds a niche from growing and protecting itself. We are all to blame for not doing what Ramon did and demand openness and honesty in public organizations.
A wonderful comment has come from the Chief Constable of West Yorkshire, Sir Norman Bettison: I’m not worth £213,000. This wage bill is mad. He comments on the Sheehey recommendation that top public sector jobs should match private sector CEO pay: “What nonsense! Furthermore, it now looks to have been costly and irresponsible nonsense. People join, and remain in, the public sector because of a sense of vocation — to make a difference to society or to the quality of people’s lives. The best leaders are those who can secure long-term public value and a vision for their staff. Not some mercenary performance manager peddling a short-term fix.”