Abstract
A staff college 1 will bring the NHS into line with many other large organizations, however creating a cadre of experts does not guarantee progress, those not selected may become apathetic, and the experts may form cliques indifferent to changing circumstances. 2 This College's graduates, however, will be appropriately ambitious, being expected to be a critical mass which transforms the huge NHS workforce where the majority is neither doctor nor nurse, by leadership with a clinical perspective, enthusing staff to deal dutifully with unusual situations, thus restoring the coping organization esteemed by staff and users, but rarely by managers.
A welcome change, one completely reversing the past direction of the NHS, a rampant bureaucracy; inserting more and more managers, closing hospitals and coalescing into large specialist centres, isolated from local involvement or criticism and empowered by an eye-watering investment in computer systems. But how exactly can leadership, formerly by exemplary professional behaviour, be exerted when the relationship between doctor and patient is no longer private and is expected to be based on explicit rules, 3 not ad-hocery – by email?
There is a further uncertainty. Speaking prosaically, what the College will do is equip its graduates with the mission skills to re-engineer the NHS: a worthy aim, but the model staff college does more than upskill its students in procedures to meet current needs, it enrols and develops visionaries with the intuitive ‘coup d’oeil’, to quickly perceive new truths and somehow or other deal with tomorrow's unpredictable reality. 4 Whatever surprises the future holds, there is already a clear trend, widespread and no less threatening than local scandals: the accelerating cost of healthcare underpinned by the steady rise in consumption. 5 An overstretch for which the NHS ideal of comprehensive healthcare for all, however lead, will need a new game plan.
Footnotes