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Thursday, 12 November 2015


One of the Dame's good friends sent her this fascinating report produced by six young NHS doctors...
Such common sense from the coal face

Reform bulletin: An NHS leadership team for the future
Yesterday Reform published An NHS leadership team for the future. The report is available here. The report, written by six young NHS doctors, recommends that medical students should learn how to be managers. In a foreword to the report, Sir Bruce Keogh, National Medical Director for NHS England, argues that, “having clinicians in leadership roles is as important to patient care as being a professor in medicine, surgery or primary care”.

The authors are four junior NHS doctors and two medical students. They argue that the Francis Inquiry identified “professional disengagement” by senior clinical staff as a key contributing factor to the tolerance of poor-quality care. They point to an international body of evidence showing clinician leaders can play a key role in improving care quality and changing NHS services.

In his foreword, Sir Bruce Keogh says: “In recognising the leadership and management potential of junior doctors, the UK is well placed to draw on a major pool of latent and willing talent.”

In a second foreword, Sir Hugh Taylor, Chair of Guy’s and St Thomas’ NHS Foundation Trust, writes: “… for some reason clinicians in our system have, too often, been encouraged to see leadership and management as a separate ‘dark art’ from which they are excluded and, too often, despise. Disengagement has, sometimes disastrously, been the result. I think the authors of this report are right to diagnose a systemic failing in the NHS to break through this barrier. In particular, I strongly welcome and endorse the trenchant call for existing training programmes to deal systematically with change management and improvement methodologies.”

The report’s key recommendations are:
  • Medical schools must integrate management training into undergraduate curricula: “Medical schools nationwide should accelerate implementation of healthcare management options into undergraduate curricula” (page 53).
  • The NHS should provide a career path for doctors who wish to pursue clinical leadership or management: “The career path for clinicians with leadership aspirations is often unclear. If leadership programmes are to be effective, they must support those participating in them to identify the best way to pursue a career that develops their interests. Physicians have traditionally followed a career that develops their interests. Similar pathways, however, do not exist for those wishing to pursue careers with a leadership or management focus” (page 57).
  • The NHS should develop a national programme for emerging clinical leaders: “The formation of NHS Improvement presents an opportunity for a nationally coordinated process to train and place emerging clinical leaders to support quality improvement within provider organisations…There is a need for a single NHS clinical leadership talent management pipeline” (page 56-57).


  1. There are so many armchair strategists spouting nonsense about the NHS that it is refreshing to see some common sense like this coming through. Lets hope that the recommendation to train doctors how to manage does not get lost in the noise. Amazing that this is not done already.

    1. Here here!

      There are many self appointed "experts" and Think Tanks waffling about the NHS. All too often the principal actors (patients and doctors) are not part of the deliberations. In fact they rarely are.

      Wonderful to see recommendations like this (from doctors) coming through. And endorsed by the top guy (Sir Bruce Keogh)

    2. Now the Dame is an expert on hospitals. Versatile old bag.

    3. If you have nothing more pertinent to add to the topic you should butt out

    4. anonymous at 08:16. Wow, you get up early.... Next time you read this blog finish your porridge first, as it will revitilise your brain cells, should you have any.... Elsewise, just shut up ad make sure you are on time in your Horton Street office....amen

  2. Kensington Patient13 November 2015 at 06:18

    The Royal Borough is host to some of the biggest and most important hospitals in the country. (Charring Cross, St Marys, Hammersmith, Brompton, Chelsea and Westminster, Marsden) and patients know how often they are let down by appalling administration that finds its way through to poor quality measured in terms of treatment outcomes. The Imperial Group of hospitals (Charring Cross, Hammersmith, St Marys) has one of the most appalling cancer results in the country and has been roundly criticised by McMillan Nurses.

  3. "Consultations" have also become part of charade of NHS bureaucrats. The hospital trusts like Imperial hold regular meetings to brief the public about how well they are doing when elective statistics are displayed showing improvements on last year.

    The really meaningful statistics (such as medical outcomes and mortality rates compared with the USA and European countries) are never displayed. Reason? The comparisons are an embarrassment.

  4. When "caring" is taken over by bureaucrats, who insist on endless forms to be filled in about waiting times, cleaning times, feeding times, in order to publish huge reports that no one reads, except for politicians who then make speeches about what a shambles their predecessors were, then the NHS is well and truly fucked.

    Doctors get demotivated, and patients get bad treatment

  5. Doctors know about medical treatment. They need to make the judgements. And if they care about what they are doing and motivated by their job, they will make the right judgements and act in the best interests of patients.

    Believe in medical professionals. Delegate power. And train them to handle it. Dabbling politicians and out of their depth administrators have created a huge mess in the NHS

  6. Sadly, there are not many Doctors or medical professionals who want to be 'administrators'. Most will tell you that they were trained in MEDICINE and they want to administer the MEDICINE, rather than the paperwork that comes with it.
    It would be wonderful if some of them opted to be pen-pushers, May be the time has come for this to happen.. we shall see...

  7. Doctors know what is wrong with the NHS. What they do NOT need is a layer of bureaucracy superimposed between them and patients which requires endless forms to be filled in and instructions issued by people without the first clue about medical matters.

    The basic test of a good organisation is "happy customers (patients) and happy staff (doctors)". It is not rocket science. If one group is unhappy there is a bad problem. If both are unhappy, there is a disaster.

  8. GPs are fed up. Hospital consultants are pissed off. Junior doctors are striking. News Papers are constantly running stories of patient horror stories. Malpractice claims against the NHS are rising at 70% per annum and currently running at £5 billion per year. Politicians (all parties)are constantly reorganising the NHS and consultants are charging huge fees to dabble.

    Put doctors and Matrons back in charge......

  9. Retired Chief Executive14 November 2015 at 07:12

    Always a difficult decision, the Government has decided to spend 9% of GDP (£120 billion) on a national health service (the NHS).Some more money is spent in addition to this by private health providers, funded mainly by insurance.

    The second big question is how effectively is this huge amount of money being spent? The basic measure is health care quality. By any comparison, NHS quality is patchy. In too many cases (eg Stafford) it is appalling. Anyone who has run organisations has an instinct for where things are going wrong. And when you find that hospital consultants are demotivated, GPs are fed up, and junior doctors are striking, and the London Ambulance Service is having to staff itself with Australians on working holidays, then it is not surprising to find that newspapers and TV are constantly reporting terrible and frightening examples of dreadful medical results.

    Without question there is a big problem to fix. I would spend less time paying management consultants and Think Tanks for advice. I would spend more time talking to doctors and patients to find out how to fix the broken system. In my experience, customers and managers always have the answers - if you are prepared to listen to them.

    1. If I needed hospital treatment, I would like to find a hospital run by Sir Lancelot Sprat and his Matron (Hattie Jakes). The Carry On series captured exactly how hospitals should tick,

    2. In the old days it was "the patient comes first". Oh, if only these days could return.

  10. Coleville Resident15 November 2015 at 08:03

    Retired Chief Executive talks sense. Get the Administrators and politicians (and management consultants) out of the NHS. Give it back to doctors and patients to manage.

    The politicians and administrators have had enough time to prove themselves. More than 50 years of playing with something that they do not understand, they have produced a disaster. Time for the cockroaches to move on

  11. Doctors are in this 356 days a year. They are fully engaged. They just need to be fully motivated and not pissed off by the politicians and administrators.

    Engaging patients is more of a problem. We are part time and need a hospital (on average) only twice in our life. And "free at the point of need" tends to make us take the disaster service for granted. "NEARLY free at the point of need" could energise the patient class and make us take an interest. A small contribution for a GP visit and hospital visit would make us all sit up - and create a powerful force for reform in the NHS.

    It is incredible what happened in universities after the introduction of student fees. Lecturers stopped taking students for granted and the quality of teaching has shot up

  12. Alan Milburn abolished the Community Health Councils that did a fantastic job working with patients, users and community groups to provide the patient, user and community voice in the NHS. None of the replacement mechanisms have worked properly. He abolished them because his wife had an affair with a CHC manager. Shame on New Labour.

  13. Put doctors and Matrons back in charge!

    I come from a family with some medical members. This had been their cry from the beginning. So much so that two members went to work in the USA to escape the bureaucracy.


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