Helen Martin: Managers must work for doctors

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CERTAIN areas of life rely almost 100 per cent on systems. Water supplies, food distribution and medicine dispensaries depend on systems for smooth operation and safe delivery.

Where systems are a pest and a danger is when they become more important than the skill, product or service they are meant to be supporting. Call centres are a case in point, where minimally informed or qualified “customer care” staff following a tick-box system cause chaos for customers and put them off for life. BT has been particularly awful in our experience.

But even they cannot compete with the systematic buffoonery in the NHS which is over-burdened by layers of managers who know the price of everything but the value of nothing and who impede and obstruct the work of hospital consultants and nursing staff by sticking their officious noses in where they don’t belong.

The problem is that the Government has invested a lot over the years in NHS managers, creating a new “professional” sector with which we now seem to be stuck. And one of politicians’ first options when they recognises the service is under threat is to pump even more money or effort into “the system” and those who manage it.

Once upon a time hospitals were run by medically qualified clinical directors. Not only did they have the significant advantage of knowing what they were talking about, but other doctors and nurses were infinitely more likely to listen to them than a passing “suit” who couldn’t tell a tumour from a toastie, who regards the system as sacrosanct and patients as a commodity, and who sees their role as tying medics up in reams of paperwork and targets, leaving them free to run (or ruin) the show.

If you have a doctor in your family, a friend or neighbour, you only have to mention managers, or targets to send their blood pressure up.

But even I cringed when I heard the patronising response of Shona Robison, Cabinet Secretary for Health, insisting, in the face of the fiercest criticism from doctors and nurses, that the Government had actually made “substantial” progress and that she was “encouraged to see professional bodies making a positive contribution”. Thank God she isn’t in the diplomatic service.

Professional bodies have been trying to contribute for years and years but no-one listens to them when they say the condition of the NHS is critical, if not potentially fatal.

Management systems have a role to play, of course they do. But it’s a more menial role answering to clinicians who, after all, are the only ones qualified to decide who needs surgery and who doesn’t, who needs immediate treatment and who can wait, and how many staff are needed and when. The chances are if you have a medical degree, you can also count and run a budget.

Sadly we now seem to be in, or approaching a situation where the managers tell clinicians how many staff they will have, which and how many procedures and operations can go ahead, in what order and where they should be available.

Unchecked, this deadly practice, this terminal misinterpretation of what the NHS is for and how it should be run, will lead to the premature death of the patient and subsequently, the rest of us.

TV licence fee is a major turn-off

HERE’S my message to Danny Cohen, the BBC’s director of television, who is threatening to cut programmes, TV channels or radio stations if licence fee dodgers are no longer required to appear in court or all over-75s become exempt from the fee.

Go on then Danny boy. Axe programmes, channels, stations. See if we care. There are dozens of channels even on Freeview, none of which demand money with menaces like the BBC. The £145.50 fee isn’t only an anachronism, it is beyond the reach of many in Britain today.

The BBC is a pay-for channel and should be treated like one. If we can’t or won’t pay the licence, find a way to take away the service. But taking people to court for failing to pay for something they didn’t ask for and may not want is ludicrous.

Are you sitting uncomfortably? Well, hard luck

IT’S all very well public health experts saying office workers should stand for two to four hours a day as sitting too long at a desk can contribute to cancer, diabetes and obesity, but the chances of today’s businesses shelling out for furniture with a stand-sit option for millions of screen workers are slim to non-existent

So, in this world of desktop computing, and long working days, what exactly is anyone expected to do with this information . . . she wrote after sitting at a desk for six hours.