In this programme there seemed to be a real power struggle between the consultants and the managers. In your opinion, who is actually running our hospitals?

That’s a very good question, and I think the answer - and the programme I think pretty well points to it - is that there is no clear running of the hospitals. You have management lines and you have people reporting to your management lines, but you then have people reporting up through the nursing lines, you have people reporting up through the individual specialties, clinical specialties, and other than the chief executive, there is no structure within which normal reporting, everyday occurrences can be dealt with, can be changed, can be altered. Nobody is running them. And for me the real lesson was to try and get that message very firmly and clearly into Brian’s head; he had to run it, and he had to run it now. And I do think that of all the stuff that we talked about, that was by far the most important, getting him to see that as a manager he had the right, he had the capacity, and he actually had the ability to manage, getting him to see that.

What was your reaction to what you were facing?

My initial reaction was that actually things could very definitely be done. There was no question about that that you could very definitely do things if you got people on board to do them, and in fact in a number of areas we did have some quite early successes with very little, well no money involvement, and just getting people to look very slightly differently at the way that they did things. But to get the whole group of people, you know, the medical side and the management side plus all the other ancillary services on board, that was the frustratingly difficult part, and there was one stage in particular where I thought my God, this is all so simple, but it ain’t going to happen, and it ain’t going to happen because people aren’t going to see it and they’re not going to be prepared to change. Very, very frustrating because the answers were very simple, they were very obvious, and I don’t even think anyone argued that they weren’t right answers. It’s just that there’s a kind of sense of they may be the right answers, but it’s very difficult to make it happen.

Can you give an example of where you encountered this

Well it was in particular around children’s health, where just getting a group of consultants simply to agree that they were going to take on a couple of extra patients every time they opened a clinic, which was twice a week on average, and that there was space and time to do that, nobody argued, but just getting it to happen, getting people to make the bookings, get the thing underway, just take away the idea that it had to be discussed another 427 times, just getting it to happen was very difficult. And it’s often the way in management, the answers nearly always are relatively straightforward. It’s getting people to do it time after time after time. And particularly in this kind of organisation where they’re just not used to it.

Does it take a special kind of manager to run a hospital or could any corporate manager do it?

I think it’s exactly the same. I think management skills are a relative rarity. I think they’re very expensive to buy because people can be paid in commercial organisations quite a lot of money. I think you can apply management skills or have people there who have the detail of what you do in terms of how you run a hospital, how you run a particular department within a hospital, how the NHS works. You can learn all of that. What you can’t learn is a capacity to lead and to make people very excited about what they’re doing and to give them that sense that you can change it now, you can make it happen now, and my God, isn’t it fantastic that we can. That’s a rarity, and unless you’re prepared to pay for that capacity, you’re not going to get it. You’re really not.

Content last updated: 14/12/2006

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