Abstract
The NHS must train more clinician managers. It was a historic mistake to create a manager class who were not doctors. These are not the words of a royal society, medical college or the British Medical Association. No, these are the musings of Jeremy Hunt, Secretary of State for Health, towards the end of a year that he spent bashing doctors.
For once, Mr Hunt has a point. Less so in relation to his questioning of non-clinical managers. Management is a skill that isn’t taught at medical school, developed during clinical training or well established among doctors. Hence, when the NHS needed managers, it looked elsewhere. Why not turn to the professionals? Now, of course, the quality of managers varies as widely as does the quality of doctors, but career managers working in the NHS face the same impossible calculus that clinicians do: how to deliver a satisfactory service in an age of rising demand and austere funding.
On this latter issue, Mr Hunt combined his carrot towards clinician managers at an NHS Providers conference with a stick to beat delegates who had called for increased funding for the NHS. In Mr Hunt’s mind, the NHS has received more money than other government departments and that means people working in the NHS should be satisfied. Clearly, more money doesn’t mean enough money, but Mr Hunt thinks it does, especially when he still believes that efficiency savings are realistic. In healthcare, take revalidation as another example, the current focus is on the stick rather than the carrot. 1
Where Mr Hunt does have a point is in his call for more clinician managers, both doctors and nurses. The NHS is not a widget factory. The products of the service are diverse, complex and unpredictable – and best understood by clinicians with experience of patient care. That doesn’t mean that clinicians don’t need to work with non-clinician managers who bring leadership experience from other fields, but we do need skilled clinician managers and we need more of them.
Mr Hunt is planning postgraduate training and hopes to send bright clinical leaders to foreign universities and support them to obtain health-focused business degrees. These are all worthy ambitions, but the deficiencies in training start in medical school, and until medical schools adopt management as a clinical specialty, doctors will find the transition to management a difficult one.
Another weakness of medical training is teaching in research methods. Our monthly selection from the James Lind Library is a useful way of developing a deeper understanding. This issue includes the first of two fascinating articles on the evaluation of Cinchona bark and quinine for treating and preventing malaria. 2